Search

The benefits of oral anticoagulation (OAC) therapy are undeniable. However, such treatment is contraindicated in 2%-10% of patients. According to the latest guidelines, percutaneous left atrial appendage occlusion (LAAO) may be considered in stroke prevention.We analyzed the data of patients from the Polish population, who had undergone LAAO procedures in the Silesian Province based on limited reports.The data from the SILCARD database of all patients who underwent LAAO between 2006 and 2019, and the data from the databases of the centers performing the procedures in the Silesian Province were included in the LAAO SILESIA registry. We analyzed the efficacy and safety of the procedure and its relationship with the occurrence of stroke and bleeding in the post-hospital follow-up.We analyzed 649 patients with the mean values of CHA2DS2-VASc and HAS-BLED scores of 4.1 and 3.2, respectively. The predominant indication for LAAO was a history of bleeding during OAC. The most frequent in-hospital major adverse cardiac events were anemia, which required blood transfusion (5.5%), and pericardial effusion, which was treated either conservatively (0.9%) or interventionally (1.2%). During hospitalization, stroke was detected in 4 patients and three patients died of any cause. LAAO reduced the annual risk of stroke by 84% and the annual risk of bleeding by 27%.Based on a "real-life" cohort of patients from the Silesian Province, we concluded that LAAO is related to low in-hospital major cardiovascular adverse events. In the long-term follow-up, LAAO reduced the rates of stroke and bleeding.

Celem niniejszej pracy było zdefiniowanie pojęcia kardiologicznego zespołu X w oparciu o najnowsze badania, określenie jego powiązań z zaburzeniami psychicznymi i przedstawienie aktualnych kierunków w terapii. Kardiologiczny zespół X został wyodrębniony w 1973 roku celem opisania grupy chorych z objawami zespołu wieńcowego przy prawidłowym obrazie naczyń wieńcowych w badaniu koronarograficznym. Mimo upływu lat, sama defincja zespołu i kryteria diagnostyczne nadal budzą kontrowersje. Szacuje się, że od 10 do 20 procent osób poddanych koronarografii, to chorzy z kardiologicznym zespołem X, w zdecydowanej większości są to kobiety w okresie okołomenopauzalnym. Ta populacja chorych znacznie częściej niż populacja ogólna cierpi z powodu zaburzeń lękowych, objawów depresji i zaburzeń snu. W leczeniu zastosowanie znajduje szereg leków o różnych mechanizmach działania, jednak ich skuteczność jest ograniczona, a istotnym elementem terapii są działania pozafarmakologiczne. Grupa chorych na kardiologiczny zespół X wymaga okresowej kontroli, gdyż prospektywne obserwacje wykazały, że jest to grupa ryzyka rozwoju miażdżycy i ostrych zespołów wieńcowych.

Cardiovascular diseases, including coronary heart disease still consititute the main reason for deaths and permanent disabilities all over the world. The role of somatic factors in the process of their development is very well- -researched thus cogent and the knowledge on the influence of behavioural and personality-related factors is often underappreciated. There is, however, successive influx of information about the relationship of personality and development, course of cardiovasular diseases lately. The aim of the work is to depict the relationship between the type D personality and coronary heart disease with special emphasis on the influence of type D personality traits on how the disease progresses and its prognosis.

Background: The revascularization of carotid arteries minimizes the risk of future cerebral stroke and usually improves cognitive functions. The aim of this study was to assess changes in cognitive function and verify the hypothesis assuming an improvement of selected cognitive functions—psychomotor speed, visuospatial episodic memory, executive function and verbal fluency—in patients after carotid artery stenting during a 12-month follow-up. Methods: 47 persons subject to CAS, including 13 symptomatic persons, were examined before and 12 months after a procedure with a psychological test battery (digit symbol test—DS, Rey–Osterrieth complex figure test—ROCF, Wisconsin Card Sorting Test—WCST, letter verbal fluency—LVF). Sociodemographic data and clinical parameters were acquired from an author questionnaire. Results: The one-year follow-up, after the performed CAS procedure, demonstrated a significant improvement of psychomotor speed, visuospatial episodic memory, and executive function. No changes in the area of verbal fluency or decline in any of cognitive functions under analysis were observed. Conclusions: Carotid artery stenting improves cognitive functioning, both in the area of basic and more complex cognitive functions in persons with carotid atherosclerosis.

Objective 75% of men with coronary artery disease confirmed by coronarography have erectile dysfunction in history, while 75% of patients with a vascular etiology of ED have significant stenoses in penile arterial vascularization. Patients with coronary artery disease have shown a relationship between the range of the lesions in the coronary vessels and erectile dysfunction intensity. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes. It analyzes seven studies which assess the results of erectile dysfunction treatment with percutaneous angioplasty. It also mentions the limitations of the cited works and formulates relevant conclusions. Conclusion Conclusions: The analysis shows that endovascular procedures in erection-related arteries are safe in a specially selected group of men. It is necessary to conduct further studies to define an appropriate group of patients who have a chance of benefiting optimally from the endovascular treatment of erectile dysfunction in a long-term follow-up.

Background: The sense of coherence is lower in patients with somatic diseases and psychiatric disorders. Purpose: The purpose of this study was to evaluate the intensity of depression and anxiety symptoms and their relationship with the sense of coherence and to try to determine the relationship between the strength of sense of coherence and symptoms of depression and anxiety with the presence of symptoms of carotid atherosclerosis in a group of patients undergoing carotid artery stenting. Methods: 35 patients, including 13 with symptomatic atherosclerosis in the carotid arteries, completed self-report tests: Hospital Scale of Depression and Anxiety (HADS) and the SOC-29 Life Orientation Questionnaire (SOC-29), 22 of whom also rated their subjective feelings of anxiety and depression on a scale included in the author’s questionnaire. Results: Both symptomatic and asymptomatic patients did not differ significantly in the severity of depression, but they differed in anxiety levels as assessed by the HADS scale. There were no differences in the overall strength of sense of coherence and its individual components. Nearly 12% of those undergoing carotid artery stenting have pronounced anxiety symptoms, and just over 14% have pronounced depression symptoms. A higher overall sense of coherence and its components are associated with lower severity of depression symptoms. Lower severity of anxiety correlates negatively with a higher sense of understanding, meaningfulness, and holistic Sense of Coherence (SOC). Manageability appeared higher in men. Conclusions: SOC is an important health-promoting factor that is preferably related to mental health parameters of patients with carotid atherosclerosis.

There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS).We aimed to assess the long‑term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy.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.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.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.

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.

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged &ge, 100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes, 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96, 95% Confidence Interval (CI): 0.94&ndash, 0.99, p = 0.012), lack of coronary angiography (HR = 0.49, 95% CI: 0.24&ndash, p = 0.048) and cardiac arrest (HR = 4.61, 95% CI: 1.64&ndash, 12.99, p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients.

Introduction Randomized trials have proven the feasibility and safety of the bioresorbable vascular scaffold (BVS) in selected populations of patients. Data concerning the results of BVS in "real-world" registries with an appropriate sample size are limited. Aim Assessment of early- and long-term outcomes of patients undergoing bioresorbable scaffold implantation in an all-comers population of the ZABRZE-BVS registry. Material and methods The ZABRZE-BVS registry is a prospective registry including consecutive patients treated in the period 2013-2016 with the intention to implant a BVS (ABSORB, Abbott Vascular, Santa Clara, California). The primary endpoint was occurrence of the 12- and 24-month device-oriented composite endpoint (DoCE) defined as cardiac death, target-vessel myocardial infarction (TV-MI) or target lesion revascularization (TLR). The secondary endpoint includes occurrence of patient-oriented composite endpoint (PoCE) at 12 and 24 months, device (lesion basis) and procedural success (patient basis). Results A total of 456 patients during 467 procedures received 588 scaffolds in 563 lesions. Of note, 25.4% of patients presented with diabetes mellitus and 62.3% had an acute coronary syndrome. In QCA analysis, 78.7% of patients had type B2/C lesions, minimal lumen diameter was 0.78 ±0.54 mm, whereas post-procedural acute lumen gain was 1.61 ±0.61 mm. Median follow-up was 781 days. The cumulative rate of DoCE was 6.7% at 12 months and 12.2% at 24 months. Rates of 12- and 24-month PoCE were 12.4% and 20.1%, respectively. The percentage of device success was 98.7%, while the procedural success rate was 96.9%. Conclusions The Absorb BVS was successfully and safely implanted in an unselected group of patients. Scaffold thrombosis developed predominantly in patients with acute coronary syndrome (ACS).

Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.

To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders.The study group comprised 30 cardiac arrest survivors, the reference group comprised 31 survivors of myocardial infarction without cardiac arrest, and the control group comprised 30 healthy subjects. The Mini-Mental State Examination (MMSE), the Digit Span test from the Wechsler Adult Intelligence Scale, Lauretta Bender's Visual-Motor Gestalt Test, and the Benton Visual Retention Test (BVRT) were used to assess the presence of cognitive impairment. An original questionnaire developed by the author was used for overall mental state assessment.The Bender test demonstrated a significant difference in the presence and severity of visual-motor skills between the study group and the control group, while BVRT and MMSE revealed increased incidence of cognitive impairment in the study group. The Bender and BVRT (D/D)/SS (version D, method D, scaled score) scales indicated cognitive impairment in 53.3% of these patients, while the BVRT (C/A)/SS test indicated cognitive impairment in 40%. For the reference group, the values were 32.3% and 12.9%, respectively. No correlation was found between the severity of cognitive impairment and the duration of cardiac arrest.Impairment of visual-motor skills, short-term visual memory, concentration, and visual-motor coordination occurs much more frequently and is more severe in individuals after SCA than in healthy individuals. Impairment of memory trace storage and recall after delay occurs more frequently in patients after SCA than in patients after myocardial infarction without cardiac arrest and in healthy individuals. SCA duration did not have any influence on the severity of the described disorders.Ocena częstości występowania i nasilenia zaburzeń wybranych funkcji poznawczych u pacjentów po nagłym zatrzymaniu krążenia (NZK) w odniesieniu do osób po przebytym zawale mięśnia sercowego bez NZK i osób zdrowych oraz analiza wpływu niektórych parametrów socjodemograficznych i klinicznych oraz czasu trwania NZK na obecność i nasilenie opisywanych zaburzeń poznawczych.Grupę badaną utworzyło 30 osób po NZK, grupę odniesienia – 31 osób po zawale serca bez NZK, a grupę kontrolną – 30 osób zdrowych. Do oceny obecności zaburzeń wybranych funkcji poznawczych użyto Krótkiej skali oceny stanu psychicznego (MMSE), Testu powtarzania cyfr ze Skali inteligencji Wechslera dla dorosłych, Testu zdolności wzrokowo-motorycznych Lauretty Bender oraz Testu pamięci wzrokowej Bentona (BVRT). Oryginalnie opracowany kwestionariusz posłużył do ogólnej oceny stanu psychicznego.W teście Lauretty Bender stwierdzono istotną różnicę w występowaniu i nasileniu zaburzeń zdolności wzrokowo-motorycznych w grupie badanej w stosunku do grupy kontrolnej, a w teście BVRT i MMSE – częstsze występowanie zaburzeń poznawczych w grupie badanej. U tych osób zaburzenia poznawcze mierzone skalami Bender i BVRT (D/D)/WP występowały u 53,3% badanych, a testem BVRT (C/A)/WP – u 40% osób. Dla grupy odniesienia wartości te wynosiły odpowiednio 32,3% i 12,9%. Nie wykazano zależności nasilenia zaburzeń poznawczych od czasu trwania NZK.Zaburzenia zdolności wzrokowo-motorycznych, krótkotrwałej pamięci wzrokowej, koncentracji oraz koordynacji wzrokowo-ruchowej u osób po przebytym NZK występują znacznie częściej i są bardziej nasilone niż u osób zdrowych. Zaburzenia zdolności przechowywania śladu pamięciowego i odtwarzania go po odroczeniu występują u chorych po przebytym NZK częściej niż u pacjentów po przebytym zawale mięśnia sercowego bez NZK i u osób zdrowych. Czas trwania NZK nie miał wpływu na nasilenie opisywanych zaburzeń.

The following description presents a case of a 75-year-old female patient with non-ST-segment elevation acute coronary syndrome in whom there occurred an infrequent complication of percutaneous coronary angioplasty: uncontrolled intracoronary stent displacement from a balloon catheter. During the attempt to retrieve the device using the “small-balloon” technique, further slippage of the stent from the balloon catheter to the right deep femoral artery was observed. Therefore, it was decided to provide a commercial intravascular microloop, whereby the stent was successfully retrieved outside the vascular system.

Background: Transcatheter aortic valve replacement (TAVR) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high risk and surgically in operable patients who suffer from severe symptomatic aortic stenosis. However, a significant number of complications, associated with both the learning curve and device specificity, have required attention and subsequent improvement. The Symetis transapical TAVR system is a self-positioning bioprosthesis composed of a non-coronary leaflet of surgical quality porcine tissue valve sewn into a self-expanding nitinol stent that iscovered with a PET-skirt. Methods: From June to September 2013 six patients have been operated on severe aortic stenosis using the new TAVR device. All patients have undergone critical assessment of a local Heart Team and have been disqualified from conventional AVR. Five were woman. Mean age was 82.3 ± 2.0 (mean LogEuroScore 23.9 ± 14.3). Four patients suffered from coronary artery disease — two had history of previous percutaneous coronary intervention with intracoronary stents, while the next two had history of coronary artery bypass grafting. Diabetes was frequent (n = 3) as well as chronic obstructive pulmonary disease (n = 4). Carotid artery disease was encountered in three patients similarly to atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 51.5 ± 11.8%, but one patient had suffered from low-flow-low-gradient aortic stenosis with LVEF of 29%. Results: The procedure was carried out successfully in all six cases. Two patients have received the valve sized L, three — M and one — S. Mean procedure time was 180 ± 19 min, mean cine 7.2 ± 1.2 min. Mean X-ray dose 930 ± 439 mGy, while mean volume of contrast given was 135 ± 61 mL. In all patients but one perivalvular leak (PVL) was not present. One patient had trace of PVL. Also, good LVEF was noted in all patients. Similar findings were obtained 30 days post procedure. No strokes, transient ischaemic attack or other cerebrovascular incidents were observed. Conclusions: This brief clinical communication reports the first Polish experience with the second generation of TAVR device — the Symetis Acurate Transapical Aortic Valve. While it lacks large patient population and longer follow-up, it reveals that TAVR procedure can be performed safely, with minimal X-ray exposure time and contrast given and successfully — with almost nonexistent PVL and no cerebrovascular incidents or heart rhythm disturbances. Heart Team approach is vital, and transapical access should not be treated inferiorly, but rather as an equally appealing TAVR option.

Due to recent advances in stent design, stenting without balloon predilation (direct stenting) has become more extensively used in patients with acute myocardial infarction (AMI). We performed a randomized study with broad inclusion criteria and early randomization after presentation to compare direct stenting with stenting after balloon predilation in patients with AMI. A total of 248 patients was randomized. After exclusion of patients not suitable for stenting, the final study group comprised 217 patients. Direct stenting strategy was feasible in 88% of patients with no meaningful complications. Final Thrombolysis In Myocardial Infarction grade 3 flow (96% vs 94%), final Thrombolysis In Myocardial Infarction myocardial perfusion grade 2 or 3 (68% vs 61%), and average ST-segment resolution after the procedure (49% vs 51%) were similar in the direct stenting and predilation groups, respectively (p = NS). Rate of in-stent restenosis was higher in the direct stenting group (30% vs 16%, p = 0.024), which was due to a worse angiographic result after the procedure. At 5 years, a composite of cardiac death, reinfarction, and target lesion revascularization had occurred in 39% in the direct stenting group and 34% in the predilated group (p = 0.40). In conclusion, although at 5 years clinical outcome did not differ significantly between groups, direct stenting was associated with a higher incidence of in-stent restenosis at 1 year. Direct stenting did not improve epicardial and myocardial reperfusion indexes. Direct stenting strategy should not be recommended in all patients with AMI as an alternative strategy to stenting after predilation.

Objectives The aim of the study was to assess the incidence of depression and anxiety symptoms in patients after cardiac arrest (SCA) in relation to patients with a history of myocardial infarction without SCA and in healthy individuals. The analysis of the impact of selected socio-demographic and clinical parameters and duration of SCA on the presence and severity of depression and anxiety symptoms in different groups was also performed. Methods The study involved 30 patients after SCA and 31 patients with a history of myocardial infarction without SCA. The control group consisted of 30 healthy subjects. To assess the mental state, a specially developed questionnaire was used, while the presence and severity of the symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HAM-A). Results Statistically, a significantly higher average level of depression and a higher incidence of anxiety was demonstrated in patients after a sudden cardiac arrest (study group) and after myocardial infarction (reference group) compared with the control group. There were no statistically significant differences in the incidence of anxiety between the study and reference groups. No impact of the duration of cardiac arrest on the incidence of depression and anxiety symptoms in the study group was observed. Conclusions In the group of people with a history of cardiac arrest, the most common mental disorder is depression. Anxiety and depression are significantly more frequent in patients with a history of SCA than in healthy individuals. There were no differences in the incidence and severity of depression symptoms in patients after SCA compared to patients after myocardial infarction without SCA. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety in the investigated groups.

CelCelem pracy była ocena poczucia koherencji w grupie kobiet poddanych diagnostyce inwazyjnej choroby wieńcowej i próba powiązania siły poczucia koherencji z krytycznymi przewężeniami tętnic wieńcowych.MetodaDo oceny poczucia koherencji użyto Kwestionariusz Orientacji Życiowej SOC-29 Antonovsky’ego oraz specjalnie skonstruowany kwestionariusz zawierający dane socjodemograficzne. Badania prowadzono przed i po 6-9 miesiącach od badania koronarograficznego. Wynik badania angiograficznego decydował o zakwalifikowaniu pacjentek do jednej z grup. Pierwszą grupę utworzyło 48 kobiet bez istotnych zwężeń w naczyniach wieńcowych, którym najczęściej diagnozowano kardiologiczny zespół X. Druga grupa obejmowała 42 osoby z potwierdzonymi, istotnymi zmianami miażdżycowymi.WynikiW grupie pacjentek z nieistotnym zwężeniem tętnic zanotowano znamiennie statystycznie niższe wartości poczucia zrozumienia w pierwszym i drugim badaniu, a także znamiennie statystycznie niższe wartości w poczuciu zaradności w badaniu kontrolnym, w porównaniu z grupą pacjentek z istotnymi zmianami miażdżycowymi. Wyjściowa siła ogólnego poczucia koherencji była porównywalna w obu grupach i nie zmieniła się istotnie po 6-9 miesiącach od koronarografii. Brak wsparcia społecznego, tendencje do przeżywania stanów depresyjnych i lękowych oraz gorsze wykształcenie związane było z niższym poczuciem koherencji w obu grupach.Wnioski1.Wyjściowa siła ogólnego poczucia koherencji nie różnicowała podgrup i nie zmieniła się istotnie po 6-9 miesiącach od koronarografii. 2.Pacjentki bez istotnych zwężeń tętnic wieńcowych mają niższe poczucie zrozumiałości przed i po koronarografii i niższe poczucie zaradności po koronarografii, w porównaniu z grupą pacjentek z istotnymi zmianami miażdżycowymi. 3.Brak wsparcia społecznego, częstsze korzystanie z porad lekarskich, tendencje do przeżywania stanów depresyjnych i lękowych oraz gorsze wykształcenie związane było z niższym poczuciem koherencji w obu badanych grupach.

The natural course of myocardial infarction (MI) leads to ischemic necrosis [(1)][1]. Experimental research indicates that hemorrhagic conversion of the myocardial necrotic area can increase the risk of serious complications of MI and may have a negative influence on its clinical course. After

The aim of the present study was to evaluate the effect of chronic total occlusion (CTO) localization in nonifarct-related artery (IRA) on 12 months mortality in patients with NSTEMI and multivessel coronary artery disease (MV CAD) treated with PCI We analyzed consecutive records of 991 patients

Background: Anxiety is a common and serious problem in ischaemic heart disease. Anxiety-associated somatisation disorders may imitate symptoms of coronary artery disease or coexist with ischaemic heart disease. Despite multiple visits to various specialists, patients with somatisation are frequently misdiagnosed and therefore mistreated. Identification of patients with anxiety disorders among patients complaining of chest pain is a prerequisite for appropriate management. By its nature, coronary angiography is a diagnostic test that can give rise to anxiety. However, dynamics of anxiety in this setting may be variable depending on coexisting mental disorders. Aim: The purpose of this study was to determine whether the presence of significant atherosclerotic lesions in coronary arteries affects anxiety level changes following coronary angiography. Methods: A group of 90 female patients who underwent coronary angiography was divided into two groups: the first one included 48 patients without significant coronary stenoses, and the other one included 42 patients with confirmed significant atherosclerotic lesions. Dynamics of anxiety level changes from the hospital admission, through the post-examination period, until 6 to 9 months after coronary angiography was evaluated with three-time measurement of anxiety using the Spielberger’s State-Trait Anxiety Inventory. In addition, intensity of anxiety as a trait was measured twice (at the first and the third examination). Results: The highest intensity of anxiety as a state was noted in both groups at the first measurement. A significant reduction in anxiety was observed at the second measurement, more pronounced in the group without significant coronary lesions. At the third measurement, women with confirmed significant coronary lesions showed the lowest level of anxiety, while the level of anxiety increased compared to the second measurement in the group of patients without significant coronary lesions. At the third measurement, women without significant coronary lesions showed a significantly higher level of anxiety compared to the group with significant coronary lesions. Intensity of anxiety as a trait was significantly lower at the final measurement in the group of patients with confirmed significant coronary stenoses. Conclusions: In women demonstrating no significant atherosclerotic lesions in coronary angiography, anxiety does not resolve permanently but reappears after several months. In this group, is seems justified to consider a diagnosis of an anxiety disorder in the form of a somatoform disorder. Those patients should be offered psychiatric therapy.

The aim of this study was to evaluate the influence of sociodemographic and clinical factors on symptoms of depression in 90 female patients awaiting coronarography.The factor dividing the patients into two groups: those without significant atheromatosis - 48 women and those with coronary atheromatosis - 42 women, was the result of invasive diagnostics of coronary heart disease. BDI (Beck Depression Inventory), HAM-D (Hamilton Depression Rating Scale) and sociodemographic and clinical data questionnaire were used in the study.It was proved that there was a connection between the appearance of increased parameters of depression and more frequent number of annual visits in the Primary Care or Cardiologic Clinic, higher level of depressiveness and anxiety, fear of obtaining information applying to the necessity of coronarography, lack of hormonal replacement therapy and of support from other people. Additionally, it was noticed that the intensity of symptoms were higher for those less educated, those waiting shorter for coronarography and those with hypertension. There were no statistically significant differences in the estimation of depressive states in both groups, neither in prevalence, nor in the intensity.Patients with increased parameters of depression need special therapies and multidisciplinary care.

Femoral artery pseudoaneurysms (PSA) develop in 0.2-8% patients undergoing procedures that require femoral artery cannulation. Ultrasound guided thrombin injection has been described as successful and safe alternative to ultrasound guided compression and surgical treatment.Assessment of efficacy and safety of PSA treatment with USGTI.28 patients (pts) (18 female, mean age 64.6 +/- 11.4) with femoral pseudoaneurysms developed due to coronary angiogram or percutaneous coronary angioplasty were treated with ultrasound guided thrombin injection. 24 PSAs arose from right common femoral artery, 3 from right superficial femoral artery, and 1 from left common femoral artery. 24 patients were receiving antiplatelet and 4 anticoagulation therapy at the time of the procedure. With ultrasound guidance, a 21Gx11/2 needle was placed into pseudoaneurysm lumen followed by thrombin injection (1074 +/- 473 U). No complications of the procedure were observed. In 24-hour observation USGTI was successful in 28 (100%) patients. However, in 7-day follow-up resolution of 1 PSA was found, which reduced efficacy rate to 96.3%.Ultrasound guided thrombin injection is a successful, safe and well tolerated method of pseudoaneurysms treatment. Neither antiplatelet nor anticoagulation therapy affects success rate of the method.

Carotid artery stenting (CAS) is, apart from surgical endarterectomy, a common method of treatment of atherosclerosis in carotid arteries. Percutaneous angioplasty of carotid artery narrowings has been developing in recent years due to introduction of neuroprotection systems, which significantly reduced number of complications. Nowadays three neuroprotection systems are in common use: filters, temporary occlusion and aspiration systems and flow reversal systems. We present three cases of successful CAS with application of three different neuroprotection systems. We discuss indications, contraindications and limitations of every device.

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.To compare the immediate and in-hospital results of PCI in patients with acute MI with or without diabetes.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.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).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.

It has been proven that presence of chronic total occlusion (CTO) in other than infarct-related artery (IRA) in patients with NSTEMI is associated with higher rates of in-hospital and long-term mortality than in patients without CTO. However, there is a lack of data regarding the influence of the