American Heart of Poland

IntroductionRadial or brachial access for endovascular treatment of peripheral arterial disease may reduce access site complications and avoid the need for post-procedure immobilization.AimThis study evaluated in-hospital, 30-day, and 12-month outcomes for iliac artery lesion treatment with these access types.Material and methodsThe study retrospectively included 109 patients, 67% males, aged 38-88 years, with chronic lower limb ischemia and atherosclerotic lesions in the iliac arteries. Endovascular treatment was performed via radial or brachial access in 22% and 78% of cases. Iliac artery occlusions, subocclusions, and significant stenoses were present in 11%, 24%, and 65% of patients. We collected data on demographics, comorbidities, procedural details, adverse events, and outcomes.ResultsDuring the hospital stay and 30-day follow-up, there were no deaths, amputations, or reinterventions. Technical success was achieved in 100% of cases, with no conversions to femoral access required. The overall complication rate related to the access site was 4.6%, with 3.6% of complications necessitating local surgical intervention. Notably, there was one minor ischemic stroke and one distal embolization during using right brachial access. All reported access site complications were associated with brachial access. The average time to discharge after the procedure was 1.2 days. At 12 months, the target lesion revascularization rate was 3.7%.ConclusionsRadial or brachial access was a safe alternative to femoral access for endovascular procedures in the iliac arteries. Using left-side radial or brachial access enabled 100% technical success.

The 2023 ESC guidelines changed previously recommended a strategy of early treatment in patients with STEMI. Pre-treatment with a P2Y12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy (Class IIb, Level of evidence B). However, the available scientific evidence justifies a personalized approach differentiating the indications for pre-treatment with oral P2Y12 receptor inhibitors depending on the concomitant administration of opioids. In our opinion, in patients undergoing primary PCI not treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be applied, while in patients undergoing primary PCI treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be considered.

Introduction and purpose Bruxism, characterized by involuntary clenching or grinding of teeth, affects individuals across all age groups, often leading to significant oral health complications and diminished quality of life. While its etiology is multifactorial, involving genetic, psychological, and physiological factors, the management of bruxism remains challenging due to the variability in its presentation. This study aims to characterize bruxism and evaluate various therapeutic interventions, including pharmacological treatments, botulinum toxin injections, occlusal splints, and non-invasive methods such as cognitive behavioral therapy (CBT), biofeedback therapy (BFT), and physiotherapy. Materials and methods A comprehensive review of recent clinical trials and studies was conducted, focusing on the efficacy, safety, and limitations of both invasive and non-invasive interventions. State of knowledge Botulinum toxin injections and dry needling demonstrated significant efficacy, though their effects were temporary. Non-invasive therapies, including CBT and BFT, were noted for their safety but showed limited effectiveness. Combining sleep hygiene with mindfulness practices produced promising results, particularly in children. Physiotherapeutic methods, such as manual therapy and home exercises, helped alleviate muscle tension and pain. Conclusions While bruxism management has advanced with diverse treatment options, challenges persist, particularly concerning the durability of effects and patient compliance. A multidisciplinary approach integrating psychological, physical, and pharmacological strategies appears essential for optimal outcomes. Further research is needed to refine therapies and establish long-term efficacy.

This study aimed to compare perioperative outcomes and long-term mortality between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting in patients with ischaemic cardiomyopathy who had a left ventricle ejection fraction of ≤35%. A retrospective cohort analysis was conducted using data from the Polish National Registry of Cardiac Surgery Procedures database, encompassing patients who underwent isolated coronary artery bypass grafting in Poland between 2012 and 2022. Patients were divided into two groups: on-pump and off-pump. Propensity score matching was used to balance the groups. The primary outcome was long-term all-cause mortality following surgical revascularization. A total of 9920 patients were included, with 3116 patients in each group after propensity score matching. The median follow-up period was 4 years. The off-pump group was associated with a lower 30-day mortality rate (6.4% vs 9.1%, P = 0.002) and fewer perioperative complications. However, long-term survival analysis revealed a modest but statistically significant advantage for on-pump group at the 10-year follow-up (P = 0.047). Off-pump provides short-term benefits, including reduced early mortality and fewer complications compared to on-pump technique. However, these advantages do not translate into improved long-term survival, where on-pump demonstrates a slight benefit. The choice between off-pump and on-pump technique should be individualized based on patient-specific factors and surgical expertise.

Introduction and Aim: Depression affects over 330 million adults worldwide and involves complex interactions of genetic, neurochemical, and endocrine factors. This review examines the role of gut microbiota in depression and explores potential therapeutic strategies.Methods: A systematic literature review was conducted on studies investigating gut microbiota composition, dysbiosis, and interventions such as probiotics, prebiotics, and dietary modifications.Results: Dysbiosis is linked to depressive symptoms through systemic inflammation, HPA axis dysregulation, bacterial metabolite changes, and epigenetic mechanisms. Observational studies identify characteristic microbiota alterations in depressed individuals. Randomized trials indicate that probiotics can improve mood and enhance standard antidepressant treatment. Dietary interventions and psychobiotics show promise as adjunctive therapies.Conclusions: Gut microbiota significantly influences depression pathogenesis and management. Microbiota-targeted interventions are emerging as effective adjuncts, but further large-scale, long-term studies are needed to standardize protocols and enable personalized treatment approaches.

This paper presents an analysis of individual procedural data from 155 interventional cardiology centers in Poland which reported their procedures to the ORPKI database in 2024.Based on National Health Fund (NFZ) data, we estimate that up to 80% of all interventional cardiology procedures in Poland are reported to ORPKI by these centers.

IntroductionHybrid coronary revascularization (HCR) is a combined approach for multivessel coronary artery disease (MVD), integrating surgical grafting of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) for non-LAD lesions. It aims to reduce invasiveness while maintaining effectiveness.AimTo summarize current evidence on the safety, effectiveness, and clinical outcomes of HCR compared to coronary artery bypass grafting (CABG), PCI, and off-pump coronary artery bypass (OPCAB).MethodsA review of current literature including clinical trials, meta-analyses, and observational studies was conducted. Focus was placed on procedural techniques, patient selection, and outcomes.ResultsHCR is associated with shorter hospital stays, reduced bleeding, and faster recovery compared to CABG. Compared to PCI, it shows improved LAD patency and fewer repeat interventions. Outcomes are similar to OPCAB, with lower myocardial injury. Despite its benefits, HCR remains underused due to technical demands and limited availability of hybrid facilities.ConclusionsFurther randomized trials are needed to confirm its long-term safety, effectiveness, and cost-efficiency.

Myocardial infarction (MI) remains the leading cause of death, especially in the elderly. To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years. We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year. A total of 14 970 patients (median age 92.7 [90.9-93.8] years) were included (4666 men and 10 304 women). Coronary angiography was performed in 47.0% of patients, percutaneous coronary intervention in 39.8%, and coronary artery bypass grafting in 0.2%. In-hospital mortality was 27.8% (25.1% in men and 29.0% in women; P <0.001). Variables independently related to the higher risk of in-hospital death were age and history of stroke, while male sex, hypertension, history of MI, and invasive management were related to a lower risk of in-hospital death. One-year all-cause mortality following discharge was 38.1% (females: 38.4%, males: 37.5%; P = 0.27), the endpoint consisting of all-cause death, MI, or stroke occurred in 42.6% patients (females: 42.8%, males: 42.2%; P = 0.44), while all-cause death or cardiovascular hospitalization occurred in 59.0% (females: 58.2%, males: 60.7%; P = 0.046). Variables independently related to the higher risk of post-discharge death were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. Participation in the managed care program following MI was linked to a lower risk of death or hospitalization for cardiovascular reasons. Variables independently related to the higher risk of post-discharge death among patients hospitalized for MI aged at least 90 years were age, heart failure, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease. When managed invasively, males have lower in-hospital mortality but higher post-discharge mortality than females.

Abstract Introduction Despite successful epicardial reperfusion with primary PCI, reactive changes in microvascular function lead to impaired myocardial reperfusion. Intracoronary SuperSaturated Oxygen Therapy (SSO2) is the only approved therapy that improves myocardial salvage in STEMI pts through the delivery of hyperbaric levels of oxygen to viable ischemic vascular and myocardial cells. Several important questions remain unanswered regarding the potential mechanisms of this benefit. Therefore, the purpose of this study is to determine the effects of SSO2 on the time course of myocardial blood flow (MBF) and the extent of microvascular obstruction (MVO) in an ischemia/reperfusion model. Methods 10 swine (32-40 kg) surviving 90-minute balloon-induced anterior STEMI, and 15-min auto reperfusion, were assigned to 120-min of SSO2 (n=5) or control (n=5) with 120-min auto reperfusion. MBF was evaluated at various time points during the experiment by injection of 15–µm microspheres (BioPal, USA) through a catheter placed in the left ventricle. Before euthanasia, 4% thioflavin-S (TS) was injected into the left anterior descending artery. The left ventricle was sectioned into 10-mm thick slices, and the myocardial rings were photographed under UV light to determine areas at risk (TS positive), MVO (lack of TS staining within TS positive area), and remote zones (contiguous areas unstained by TS). MBF was calculated as the total blood flow within the areas at risk normalized to the total flow within the remote zones. Results All animals experienced significant reduction (p = 0.02) in MBF due to balloon occlusion at the 85-minute MI timepoint compared to baseline (Fig). Following the removal of occlusion, reactive hyperemic flows were observed for both groups at the 15-minute auto reperfusion time point (Fig). Starting at the 30-min time point of autoperfusion to 120-min, the MBF significantly decreased (p=0.02) in the controls (Fig). In contrast during these time points, for the SSO2 group the MBF values were numerically higher than the controls, with average MBF for the SSO2 group being significantly higher (p = 0.03) than the controls (1.1 ± 0.18 vs 0.6 ± 0.13, respectively) at the 120-min timepoint (Fig). MVO was found within the areas at risk in all animals, but the extent of MVO in relation to the area at risk was significantly reduced (p &amp;lt; 0.001) in the SSO2 group versus controls (15.2 ± 7.3% vs 41.8% ± 6.2%, respectively). Conclusions Results from this study showed that in a STEMI swine model, SSO2 prevented reduction in MBF during the 120-min reperfusion period, with significantly increased MBF at the end of the experiment compared to controls. This flow improvement translated to a 64% relative reduction in the extent of MVO compared to controls. These results suggest that one of the mechanisms by which SSO2 improves myocardial salvage may be by limiting early microcirculatory alterations set in motion by a cascade of reduced myocardial flow and MVO.Myocardial Blood Flow vs Time