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Introduction : The accumulation of visceral abdominal tissue (VAT) seems to be a hallmark feature of abdominal obesity and substantially contributes to metabolic abnormalities. There are numerous factors that make the body-mass index (BMI) a suboptimal measure of adiposity. The visceral adiposity index (VAI) may be considered a simple surrogate marker of visceral adipose tissue dysfunction. However, the evidence comparing general to visceral adiposity in CAD is scarce. Therefore, we have set out to investigate visceral adiposity in relation to general adiposity in patients with stable CAD. Material and methods : A total of 204 patients with stable CAD hospitalized in the Department of Medicine and the Department of Geriatrics entered the study. Based on the VAI-defined adipose tissue dysfunction (ATD) types, the study population (N = 204) was divided into four groups: (1) no ATD (N = 66), (2) mild ATD (N = 50), (3) moderate ATD (N = 48), and (4) severe ATD (N = 40). Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. Results : Patients with moderate and severe ATD were the youngest (median 67 years), yet their metabolic age was the oldest (median 80 and 84 years, respectively). CONUT scores were similar across all four study groups. The VAI had only a modest positive correlation with BMI (r = 0.59 p < 0.01) and body adiposity index (BAI) (r = 0.40 p < 0.01). There was no correlation between VAI and CONUT scores. There was high variability in the distribution of BMI-defined weight categories across all four types of ATD. A total of 75% of patients with normal nutritional status had some form of ATD, and one-third of patients with moderate or severe malnutrition did not have any ATD ( p = 0.008). In contrast, 55-60% of patients with mild, moderate, or severe ATD had normal nutritional status ( p = 0.008). ROC analysis demonstrated that BMI and BAI have poor predictive value in determining no ATD. Both BMI (AUC 0.78 p < 0.0001) and BAI (AUC 0.66 p = 0.003) had strong predictive value for determining severe ATD (the difference between AUC 0.12 being p = 0.0002). However, BMI predicted mild ATD and severe ATD better than BAI. Conclusions : ATD and malnutrition were common in patients with CAD. Notably, this study has shown a high rate of misclassification of visceral ATD via BMI and BAI. In addition, we demonstrated that the majority of patients with normal nutritional status had some form of ATD and as much as one-third of patients with moderate or severe malnutrition did not have any ATD. These findings have important clinical ramifications for everyday practice regarding the line between health and disease in the context of malnutrition in terms of body composition and visceral ATD, which are significant for developing an accurate definition of the standards for the intensity of clinical interventions.

Introduction: There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS)., Objectives: We aimed to assess the long‑term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy., Patients and Methods: The analysis involved 11 021 patients treated in a single center between 2006 and 2016 who were enrolled into the ongoing PRESAGE registry. Based on the results of coronary angiography and the treatment strategy adopted, patients were classified into 4 groups: with nonsignificant lesions (n = 3637), undergoing percutaneous coronary intervention (n = 4678), undergoing coronary artery bypass grafting (CABG; n = 997), and receiving conservative treatment (notwithstanding significant lesions on an angiogram; n = 1709). All‑cause death, assessed in every study group at 1-, 3-, and 5‑year follow‑up, was regarded as the primary outcome measure., Results: The mean (SD) age of the study patients was 64.6 (9.5) years, and women constituted 35% of the cohort. Patients treated conservatively were the oldest (mean [SD] age, 64.9 [9.3] years) in the group and showed the highest prevalence of previous myocardial infarction (50.5%), CABG (31.8%), diabetes (40.3%), chronic total occlusion (65.5%), and left ventricular ejection fraction below 35% (24.4%). Death from any cause in patients with nonsignificant lesions, undergoing percutaneous coronary intervention, undergoing CABG, and receiving conservative treatment occurred 5 years following the index hospitalization in 11.2%, 16.2%, 9.7%, and 21% of those patients, respectively., Conclusions: The PRESAGE registry provides valuable information about the clinical characteristics and long‑term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long‑term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.

Few reports have analyzed the effect of pentraxin 3 (PTX3) on platelets and their activation. We explored the association between plasma PTX3 and platelet indices. Forty-nine patients with stable coronary artery disease (CAD) were enrolled. Based on median PTX3, the study population was divided into group 1 (n = 25; PTX3 ≤ 0.98 ng/mL) and group 2 (n = 24; PTX3 > 0.98 ng/mL). Platelet indices investigated included mean platelet volume (MPV), platelet distribution width (PDW), platelets and large cell ratio (P-LCR), MPV to platelet count ratio (MPV/PC), platelet to lymphocyte ratio (PLR), and MPV to lymphocyte ratio (MPVLR). Patients with lower PTX3 had a higher lymphocyte count. Platelet count was similar in both groups. Notwithstanding, patients with higher PTX3 concentrations had elevated MPV (8.3 vs 10.0 fL; P < .001) and PDW (9.4 vs 12.4 fL; P < .001). However, the MPV/PC ratio was similar in both groups. Thromboinflammatory biomarkers (PLR, MPVLR) were also elevated in group 2. Pentraxin 3showed a strong, positive correlation with MPV ( r = .75, P < .01) and PDW ( r = .80, P < .01), and weak to moderate correlation with MPVLR. In conclusion, PTX3 is associated with larger platelet size as assessed by platelet volume indices. There is a strong correlation between plasma PTX3 level and MPV and PDW.

Aims: Diabetes mellitus (DM) is one of the most frequently detected conditions in multimorbid disease clusters. Platelet activation is one of the key mechanisms underlying atherothrombosis in acute myocardial infarction. Available data link mean platelet volume (MPV) to poor prognosis not only in cardiovascular and non-cardiovascular disease. Given the lack of research data on the association between disease clusters and MPV, we have set out to investigate the link between multimorbidity and MPV in diabetic patients with acute myocardial infarction., Methods: A total of 277 patients with DM and STEMI undergoing primary percutaneous coronary intervention were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N = 58) with ≤ 1 comorbidity and group 2 (N = 219) with ≥ 2 comorbidities. A subanalysis was performed within the multimorbidity group: group 2A with two or three comorbidities (N = 156) and group 2B with at least four comorbidities (N = 63)., Results: In the study population, 15.9% of patients had one comorbidity, and 22.0, 34.3, and 22.7% of patients had two, three, or at least four comorbid conditions, respectively. Both MPV and PDW were elevated in multimorbid patients (9.3 vs 10.8 fl and 9.5 vs 10.3 fl, respectively). The highest platelet volume indices were observed in patients with at least four comorbid conditions. There was a moderate positive correlation between MPV and the total number of comorbidities, the number of CVD comorbidities, and the number of non-CVD comorbidities., Conclusions: These findings indicate that multimorbidity is associated with an increase in platelet volume indices. MPV values increased with the increasing number of comorbid conditions. Importantly, MPV values were elevated in some, but not all CVD and non-CVD conditions.

Introduction: There is an increasing body of evidence on the clinical importance of multimorbidity, which is defined as the coexistence of two or more chronic conditions. Type 2 diabetes (T2DM) is one of the most frequent chronic conditions. Most adults with type 2 diabetes have at least 1 coexisting chronic condition and approximately 40% have 3 or more. Prior studies have suggested that cardiovascular (CVD) and non-CVD comorbid conditions yield worse outcomes in patients hospitalized with ST-elevation myocardial infarction (STEMI). It is unclear, however, the extent to which multimorbidity has a cumulative effect on long-term risk. Therefore we have set out to determine the prognostic value of multiple comorbidity on long-term outcomes in this population of patients., Methods: A total of 277 patients with T2DM and STEMI undergoing primary percutaneous coronary intervention (PCI) were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N=58) with ≤ 1 comorbidity and group 2 (N=219) with ≥ 2 comorbidities., Results: Comorbid conditions were prevalent among study participants (Figure 1). The median number of comorbidities was three. 15.9% of patients had one comorbidity and 22.0%, 34.3%, and 22.7% of patients had two, three or at least four comorbid conditions respectively. A majority of patients had at least one CVD comorbidity (6.1% of patients had none), whereas 53.1% of patients did not have any non-CVD comorbidity. During hospitalization 3 out of 58 patients (5.2%) died in group 1 and 25 of 219 patients (11.4%) died in group 2. The number of comorbid conditions was not an independent predictor of in-hospital death. During 12-month follow-up, 5 of 58 patients (8.6%) and 42 of 219 patients (19.9%) died, respectively in group 1 and 2 (P=0.05). The number of comorbid conditions proved in ROC analysis that for 12-month mortality, the prognostic value was modest, but for 12-month acute coronary syndromes the prognostic value was good. Increase in the number of comorbid conditions by one was associated with a 15% increase in the relative risk of 12-month mortality and a 41% increase in the relative risk of 12-month acute coronary syndromes (ACS)., Conclusions: Comorbid conditions are highly prevalent among these groups of patients. Majority of patients have at least 2 other cardiovascular comorbidities and one or two non-cardiovascular comorbidities. In terms of long-term follow-up, multimorbidity was associated with worse outcomes. The risk of both long-term mortality and ACS increased with the increasing number of comorbidities. In summary, our findings highlight the importance of indentifying patients with multimorbidity. This, in turn, could allow for provision of better care to these high-risk and complex group of patients., Competing Interests: CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.

Aim: There has been a rise in contrast-induced acute kidney injury (CI-AKI). We examined the role of platelet-to-lymphocyte ratio (PLR) in predicting CI-AKI episodes in patients with myocardial infarction (MI) and diabetes., Methods: A total of 719 patients with diabetes and MI were enrolled. Study population was divided into: group 1 (n = 615) without CI-AKI and group 2 (n = 104) with CI-AKI., Results: Patients with CI-AKI had higher in-hospital mortality and a longer in-hospital stay. Median PLR was higher in patients with CI-AKI. Receiver operating characteristic analysis indicated PLR to be a good predictive tool in assessing the risk of CI-AKI. PLR was an independent predictor of CI-AKI (OR: 1.22; p < 0.0001)., Conclusion: These results suggest potential role for PLR as a biomarker of CI-AKI among diabetic patients with MI who undergo percutaneous coronary intervention.

Trimetazidine (TMZ) exhibits metabolic and cardioprotective effects. The aim of this study was to assess the effects of TMZ on interleukin-2 (IL-2) and interleukin-8 (IL-8) serum concentrations in 156 patients with stable coronary artery disease. They underwent a treadmill exercise test (TET) before and after 3 months of TMZ treatment. IL-2 and IL-8 concentrations were determined before and after each TET. Before treatment, TET did not influence IL-2 concentrations, whereas IL-8 concentrations increased. TMZ treatment led to a decrease in IL-2 concentrations before TET, as well as it prevented the increase of IL-8 following the second TET. Obtained results confirmed the improvement in TET performance during TMZ treatment and they revealed a significant influence of TMZ on IL-2 and IL-8 concentrations both before and after TET. These changes may reflect potential anti-inflammatory effects of TMZ.

Aim: We investigated prognostic value of novel simplified thrombo-inflammatory score (sTIPS) in patients with ST-elevation myocardial infarction (STEMI) and diabetes mellitus., Methods: A total of 465 patients with diabetes mellitus and STEMI were included in the study. Based on admission cut-off values for predicting in-hospital mortality of white blood cell count (>13.4 × 10 3 /mm 3 ) and mean platelet volume-to-platelet count ratio (>0.06), the patients were assigned 0 point for having the lower value of each variable and 1 point for having the upper value of each variable. sTIPS was calculated as the sum of these two variables., Results: Kaplan-Meier curves demonstrated that higher sTIPS categories were associated with higher in-hospital and 12-month mortality. One-point increment in the score was associated with 51% increase in the risk of in-hospital death and 89% increase in the risk of long term., Conclusion: sTIPS is useful in predicting worse immediate and long-term outcomes following STEMI.

Aims: TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF., Methods: A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA2DS2-VASc score of 2 or 3; group 2 (N = 257) with a high CHA2DS2-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA2DS2-VASc score of 6 or higher., Results: In diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 (interquartile range 3-5). In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57-0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71-0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %., Conclusions: In diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management., Competing Interests: Compliance with ethical standards Funding None. Conflict of interest The authors have no commercial associations or sources of support that might pose a conflict of interests. Human and animal rights All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent Informed consent was obtained from all patients for being included in the study. Informed consent for data analysis was obtained from the patients according to the Polish law on patients’ rights regarding data registration. Approval for analyzing recorded data was waived by the local bioethics committee on human research given the retrospective nature of the study.

Introduction: Platelet activation and hyperreactivity plays a pivotal role in developing intravascular thrombus in ST elevation myocardial infarction (STEMI). Mean platelet volume (MPV), which is readily available in clinical settings, has been linked to poor prognosis following STEMI. Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a new marker of worse outcomes linking inflammation and thrombosis. We investigated the prognostic significance of the new marker, MPVLR, in diabetic patients with STEMI undergoing percutaneous coronary intervention (PCI)., Methods: A total of 623 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled and divided based on the median MPVLR on admission into two groups: group 1 (N=266) with an MPVLR ≤4.46 and group 2 (N=257) with an MPVLR >4,46., Results: Despite similar clinical features patients with elevated MPVLR (group 2) had worse angiographic characteristic suggestive of a higher thrombus burden. In-hospital and one-year mortality was higher in group 2. ROC analysis revealed moderate diagnostic value in predicting in-hospital mortality (adjusted HR 1.13; 95% CI 1.04-1.23; P=0.003; MPVLR cut-off >6.13) similar to that of PLR a good diagnostic value in predicting long-term mortality (adjusted HR 1.52; 95% CI 1.42-1.63; P<0.0001; MPVLR cut-off >5.88) better than that of PLR. MPVLR remained an independent risk factor of early and late mortality., Conclusions: To the best of our knowledge, this is the first ever study that has investigated MPVLR. Despite similar clinical characteristics, patients with elevated MPVLR had worse angiographic features which may indicate a greater thrombus burden. Elevated MPVLR is an independent risk factor of early and late mortality following STEMI. In addition, it has similar value to PLR in predicting in-hospital mortality, and a better value than PLR in predicting long-term mortality., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Red blood cell (RBC) transfusion can be lifesaving. However, in many clinical cases, including acute coronary syndromes, percutaneous coronary interventions (PCI), cardiac surgery, and acute critical care, detrimental effects (excess death and myocardial infarction [MI], and also lung infections) have been observed in patients after a RBC transfusion., Aim: To evaluate the long-term impact on the prognosis of patients who received a RBC transfusion after PCI for the treatment of ST-segment elevation MI (STEMI)., Methods: Between 1999 and 2004, 2,415 consecutive patients, with an STEMI treated with PCI, were included in the analysis. The patients were divided into two groups: 82 patients with a RBC transfusion (3.5%) and 2,333 without a RBC transfusion (96.5%)., Results: The in-hospital mortality rate was 15.8% and 4.2% (p < 0.0001) and the five-year mortality rate was 42.7% and 19% (p < 0.0001) for patients who received and who did not receive a RBC transfusion, respectively. Moreover, multivariate analysis revealed that, after correction for baseline differences, RBC transfusion was an independent predictor of five-year mortality in patients treated with PCI (HR 1.45; 95% CI 1.0-2.1; p = 0.04)., Conclusions: Red blood cell transfusion is associated with higher five-year mortality in STEMI patients treated with PCI.

Background: The presence of normal thrombolysis in myocardial infarction (TIMI) fl ow grade 3 before percutaneous coronary intervention (PCI) is associated with better outcomes. The aim of this study was to evaluate the association of spontaneous reperfusion (SR) before PCI and its effect on the immediate and long-term outcomes in diabetic patients., Methods: A total of 1,850 patients with myocardial infarction and multivessel coronary artery disease undergoing primary PCI were enrolled and divided into 4 groups: (1) patients with diabetes mellitus (DM) and initial TIMI < 3 fl ow (n = 491), (2) patients with DM and initial TIMI 3 fl ow (n = 48), (3) patients without DM and with initial TIMI < 3 fl ow (n = 1,196), (4) patients without DM and with initial TIMI 3 fl ow (n = 115)., Results: SR before PCI was similar in diabetic and non-diabetic patients (8.9% vs. 8.8%, p = 0.8). DM was not an independent predictor of either pre-procedural or post-procedural TIMI 3 flow. In-hospital mortality rate was the highest in group 1 and the lowest in group 4 (p < 0.0001). Death rates of patients from groups 2 and 3 were similar (approximately 8.3% each, p = 0.9). Non-diabetic patients had a higher 1-year survival rate than diabetic patients, irrespective of their initial TIMI fl ow., Conclusions: SR is associated with a similar post-PCI improvement in epicardial blood flow both in diabetic and non-diabetic patients. SR improves in-hospital survival of diabetic patients, which is similar to the survival of non-diabetic patients without SR. The benefi cial effect of SR in diabetic patients disappears during 1-year follow-up.

Unlabelled: Renal Angiography and IntraVascular UltraSonography (IVUS), are valuable diagnosis methods for assessment of renovascular hypertension (RVH). Endovascular techniques employing percutaneous transluminal renal angioplasty (PTRA) are effective for therapy of ischaemic nephropathy in patients with RVH. Success of PTRA is limited by a significant rate of restenosis. THE AIM OF STUDY was to compare the assessment of residual stenosis and restenosis with angiography and IVUS., Material and Methods: Residual stenosis after PTRA (combine with intravascular brachyterapy in 33 patients--group I) were assessed in 62 RVH patients with angiography and IVUS techniques. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and intravascular ultrasound (IVUS) analysis were performed to assess restenosis., Results: Residual stenosis after PTRA of atherosclerotic lesions was slightly lower with QCA than IVUS (in group I 15.49 +/- 4.69% and 18.81 +/- 4.81% and in group II 15.36 +/- 4.68% and 18.43 +/- 4.69%, respectively). The loss of lumen area in QCA assessment was slightly greater than in IVUS measurement (1.2 +/- 0.7 mm vs. 0.9 +/- 0.8 mm in group I i 1.7 +/- 0.7 mm vs. 1.5 +/- 0.8 mm in group II). The angiographic measurements of late lumen loss, diameter stenosis, and minimal lumen diameter correlated well with IVUS measurements (r = 0.81, r = 0.89 and r = 0.89 respectively)., Conclusions: Angiography and IVUS are equally effective methods for diagnosis and assessment of residual stenosis and restenosis after endovascular renal artery revascularisation.

Unlabelled: Studies have shown that HMG-CoA reductase inhibitors (statins) play an important role in the prevention and treatment of atherosclerosis and hyperlipidemia. The aim of this study was to investigate the effect of 3-month treatment with simvastatin on serum levels of Insulin-Like Growth Factor-1 (IGF-1) in patients with diagnosed hypercholesterolemia. In total, 156 patients with hypercholesterolemia were recruited for the study. The inclusion criteria for this study were designed to allow the enrollment of a representative group of patients for cytokine studies. The patients were divided into two groups: (1) patients with a mild-to-moderate risk of heart disease, who had total cholesterol (TC) < 300 mg/dl (7.8 mmol/l), LDL-cholesterol < 210 mg/dl (5.4 mmol/l), and who lacked risk factors for coronary artery disease (CAD) after treatment with a diet for 3 months; (2) patients with a high-to-very high risk of CAD, who had TC > 300 mg/dl (7.8 mmol/l), LDL-cholesterol > 210 mg/dl (5.4 mmol/l), and at least two risk factors for CAD after treatment with a diet and administration of simvastatin (20 mg/day) for a three month period. The control group consisted of ten healthy volunteers who each had a normal lipid profile. Total cholesterol, LDL-cholesterol and IGF-1 concentrations were measured at baseline and either after six months of dietary supplementation (first group) or after three months of dietary supplementation and three months of simvastatin treatment (second group)., Conclusions: In patients with mild-to-moderate risk of CAD, a decreased serum concentration of IGF-1 was observed three months after beginning a low-fat diet. However, no changes in the serum concentration of IGF-1 were noted in patients with high-to-very high risk of CAD. Additional three-month treatment with simvastatin decreased the serum concentration of IGF-1.

Unlabelled: Statins, HMG-CoA reductase inhibitors are drugs with a potent lipid-lowering effect. They are also able to inhibit proliferation of smooth muscle cells, T-lymphocytes, to restore endothelial activity and to inhibit inflammatory responses. These effects have been called the pleiotropic effect of statins. Statins have demonstrated contrast to the inflammatory activity of macrophages. The aim of the study was to assess the influence of simvastatin on serum levels of proinflammatory cytokines such as IL-2 and TNFalpha in hypercholesterolemic patients., Methods: In 58 non-smoking men with total cholesterol (TC) >7.8 mmol/L, LDL-cholesterol>5.5 mmol/L and fasting triglycerides<4.6 mmol/L serum IL-2 and TNFalpha were determined at the beginning of the study, after 3 months diet and after 3 months of simvastatin therapy (20 mg/day). The control group was composed of 10 healthy volunteers with correct lipid values: TC<5.2 mmol/L, LDL-cholesterol <2.3 mmol/L, HDL-cholesterol >1.5 mmol/L and triglycerides<2.3 mmol/L., Results: There were significant reductions in IL-2 concentration after 3 months diet (p=0.0059) and significant (p=0.0003) decrease of IL-2 after 3 months of simvastatin therapy. Meanwhile we observed a significant decrease of TNFalpha concentration after 3 months diet (p=0.0001) and no significant decrease after 3 months of simvastatin therapy.

Background: The role of inflammation in the development of atherosclerosis and its complications has been recently documented. Pro-inflammatory cytokines are among many postulated factors. It is possible that the imbalance between protective cytokines and cytokines affecting endothelial function is one of the underlying mechanisms of myocardial ischaemia., Aim: To examine the effects of simvastatin on IL-2 and TNFalpha levels in patients with hypercholesterolemia., Methods: The study group consisted of 64 males (age 20-65 years) with hypercholesterolemia. The control group was composed of 10 healthy male volunteers (age 25-40 years) with normal lipid profile. Total cholesterol, LDL-cholesterol, IL-2 and TNFalpha were measured in both groups at baseline, after three months of dietary treatment, and after a further three months of simvastatin therapy., Results: Simvastatin caused a significant decrease in the total and LDL-cholesterol levels compared both with baseline measurements (p=0.0001) and after dietary treatment (p=0.0001). Moreover, simvastatin significantly reduced the IL-2 plasma concentration (p=0.0003). There were no significant differences between IL-2 levels before and following dietary treatment. The TNFalpha serum concentration significantly decreased following the implementation of diet (p=0.0001). Subsequent simvastatin therapy caused further decrease in the TNFalpha serum concentration but this difference did not achieve statistical significance., Conclusions: A hypolipemic diet significantly decreases TNFalpha serum concentration without affecting the IL-2 level. The subsequent simvastatin therapy significantly reduces IL-2 but not TNFalpha when compared with the post-diet values.

Acute coronary syndromes (ACS) without ST elevation (which include unstable angina [UA] and non ST elevation MI [NSTEMI]) are caused by dynamic changes in the atherosclerotic plaque and coronary blood flow. To determine characteristics, in-hospital outcome and management of patients with ACS without ST elevation. The total of 502 patients were enrolled. Inclusion criteria were: rest angina within the last 24 hours, ST-segment deviation (>0,05 mV), T-wave inversion (>0,1 mV) in at least two leads, positive serum cardiac markers. There were 63,3% of patients with Braunwald's IIIB UA and 6,8% with IIIC UA, 29,9% of patients were diagnosed with NSTEMI. All patients were diagnosed invasively with subsequent revascularization (PCI-73,1% or CABG-16,7%) if apprioppriate. 1,6% of patients underwent PCI and elective CABG and 16,7% of patients were treated conservatively. Overall mortality was 2,98%--PCI subgroup (N = 367) 1,36%, CABG subgroup (N = 84) 8,33% and conservative subgroup (N = 43) 6,07%. Non-fatal myocardial infarction (MI) complicated the hospital course in 0,99%, 0,27%, 3,57%, and 2,32% of patients respectively. 1,4%, 0,54%, 6% and 0% of patients respectively had fatal MI. Early invasive strategy in patients with ACS without ST elevation is efficacious method of treatment.

Background: Although the introduction of primary percutaneous coronary interventions (PCI) improved the outcome of patients with acute myocardial infarction (MI), diabetes remains a significant factor which worsens prognosis., Aim: To compare the immediate and in-hospital results of PCI in patients with acute MI with or without diabetes., Methods: The outcome of 139 patients with diabetes and 528 patients without diabetes was compared. Thrombolytic therapy was administered prior to PCI to 43.2% of patients with diabetes and 42.4% of patients without diabetes., Results: Patients with diabetes were older, more frequently of female gender and had higher incidence of hypertension as well as multi-vessel coronary artery disease. PCI was effective in 85.6% of diabetics and 90.2% of non-diabetic patients (NS). The reocclusion rate was significantly higher in diabetics than in non-diabetics (11.5% vs 5.5%, p=0.012) whereas the incidence of haemorrhagic complications was similar. Mortality rates were comparable in both groups (7.2% in diabetics vs 5.9% in non-diabetics, NS)., Conclusions: 1) Immediate efficacy of primary PCI for acute MI is similar in diabetics and non-diabetics, however, the in-hospital reocclusion rate is higher in the former group of patients. 2) In-hospital mortality is not affected by the presence of diabetes. 3) Thrombolytic and invasive treatment of diabetic patients with acute MI is not associated with an increased risk of bleeding.

Background: In patients with acute myocardial infarction (MI), the efficacy of thrombolysis is low. Angioplasty after failed thrombolysis (rescue percutaneous coronary angioplasty [PTCA]) has been associated with an increase in the incidence of inhospital complications. It has been proposed that these complications result from the procedure itself. Thus, the aim of this study was to compare the efficacy, inhospital complications, and mortality rate of patients with MI who are treated with primary PTCA and PTCA after initial thrombolysis (rescue or immediate rescue) in an experienced clinical center specializing in percutaneous coronary interventions., Methods and Results: The study group consisted of consecutive patients with MI treated with primary PTCA (n = 195) or PTCA after initial thrombolysis (n = 179). The study was performed in a referral center with a 24-hour catheter-laboratory service. The success rate of the procedure was 90.5% and 88.2% in the PTCA after initial thrombolysis group and primary PTCA group, respectively. The groups did not differ in the frequency of reocclusion, emergency surgical revascularization (coronary artery bypass grafting), or stroke. In patients without cardiogenic shock, the inhospital mortality rates were 3.2% and 0.6% in the rescue and immediate rescue group and primary PTCA group, respectively (not significant). In a subgroup of patients with cardiogenic shock, the mortality rate was 36.0% in the initial thrombolysis PTCA group and 30.8% in the primary PTCA group. However, after successful PTCA in this subgroup, the mortality rate dropped to 18% and 10%, respectively., Conclusions: After initial thrombolysis, PTCA is safe, effective, and likely to restore grade 3 Thrombolysis In Myocardial Infarction flow in about 90% of patients. When available, immediate rescue PTCA should be performed in all patients, including patients with cardiogenic shock.

The aim of the study was a comparison of coronary angioplasty as the method of myocardial infarction treatment in the two groups of patients: 1st--aged 40 years and younger, and 2nd--older than 40 years of age. The 1st group consisted of 50 patients in the mean age of 36.5 +/- 3.5 years, the 2nd group included 617 patients in the mean age of 58.3 +/- 10.1 years. There was no difference between the two groups in pain duration, infarct localization, thrombolysis, and cardiogenic shock. The younger compared with the older patients were significantly more often of male gender: 45 (90.0%) vs 456 (73.9%), (p = 0.01). The young patients were more often smokers: 41 (82.0%) vs 393 (64.0%), (p = 0.01). There was no significant difference in an incidence of other coronary risk factors. Coronary angiogram showed that there was no significant difference between the both groups in the infarct-related artery localization, TIMI flow before PTCA and number of stenosed arteries. The frequency successful PTCA (TIMI 3 flow, residual stenosis below 30%) was similar in both groups: 45 (90.0%) vs 549 (89.1%), (p = 0.3). There was no significant difference between two groups in the efficacy of treatment, incidence of reocclusion, complications, and mortality during hospitalization.

Unlabelled: Cardiogenic shock develops in 5-15% of patients hospitalised with acute myocardial infarction. It is responsible for more than a half of all hospital deaths with survival rate of about 20%. Conventional medical therapy with use of adrenergic, vasoactive, inotropic and thrombolytic agents has failed to improve survival. Treatment strategy combine hemodynamic stabilisation with restoration of coronary blood flow. The aim of the study was evaluation of mechanical restoration of coronary blood flow in infarction related artery and to assess its influence on mortality in patients with myocardial infarction complicated by cardiogenic shock. We retrospectively analysed 58 subjects: 26 patients treated by primary angioplasty, 25 patients with PTCA angioplasty after streptokinase treatment and 7 ones treated conservatively. TIMI 3 flow in angioplasty treated patients was achieved in 70.6% with in hospital mortality rate 14%, however, when reperfusion was unsuccessful the mortality was high (80%). 12 months follow-up mortality rate was 41.8%., Conclusion: Successful reperfusion with coronary angioplasty of the infarct-related artery can significantly reduce mortality rate in patients with cardiogenic shock. Patients who survived in-hospital period have favourable one-year prognosis.