Despite significant advances in interventional cardiology and mechanical circulatory support (MCS) techniques, the outcomes of patients with cardiogenic shock (CS) complicating myocardial infarction (MI) remain suboptimal. The aim of this expert consensus was to provide information on the current management of patients with CS complicating MI in Poland, and to propose solutions, including systemic ones, for all stages of care. The document uses data from the Polish PL-ACS Registry of acute coronary syndromes, which includes records on more than 820 000 hospitalizations. The role of medical rescue teams was described, along with the necessity to expand their range of competencies at the level of prehospital care. The authors emphasized the importance of treating the underlying cause of CS and of direct patient transfer to centers capable of performing percutaneous coronary interventions. Current recommendations of scientific societies on MCS use were presented. The role of the Cardiac Shock Team in the management of patients with CS complicating MI was emphasized. Such teams should comprise an interventional cardiologist, a cardiothoracic surgeon, and an intensive care physician. Patients should be transferred to highly specialized CS centers, following the example of so called Cardiac Shock Care Centers described in some other countries. Criteria for the operation of such centers were proposed. Other important aspects discussed in the document include the role of rehabilitation, multidisciplinary care, and long-term follow-up of treatment outcomes. The document was developed in cooperation with experts from different scientific societies in Poland, which underlines the importance of interdisciplinary care in this patient population.

Atrial fibrillation is associated with significant morbidity and mortality, and its incidence is increasing globally. The primary complication of atrial fibrillation is ischemic stroke, the risk of which may be reduced with oral anticoagulant agents, i.e., either vitamin K antagonists or direct oral anticoagulants. Patients with atrial fibrillation often have concomitant hepatic impairment, particularly because of increasing rates of non-alcoholic liver disease. However, anticoagulation in patients with liver disease is challenging due to the pathophysiologic changes of the coagulation cascade and as a result, the increased risk of major bleeding in such individuals. Furthermore, monitoring of the degree of anticoagulation is complicated in patients with liver disease due to issues such as spontaneous internationalized normalized ratio (INR) elevation, changes in hepatic drug elimination, and thrombocytopenia. We review the contemporary evidence on atrial fibrillation and anticoagulation in patients with liver disease. We suggest having a strong focus on risk factor management and argue that the risk of ischemic stroke often outweighs the risk of hemorrhagic events in this setting.

The optimal revascularization strategy for non- left anterior descending coronary artery (LAD) lesions during one-stop hybrid coronary revascularization (HCR) surgery remains "evidence-free". This study aimed to compare the outcomes of drug-coated balloon (DCB) and drug-eluting stent (DES) strategy in patients with non-small non-LAD lesions undergoing one-stop HCR. A total of 141 consecutive patients with multivessel coronary artery disease (MVCAD) undergoing one-stop HCR between 1 June 2018 and 1 March 2022 were retrospectively included in this study. In-hospital outcomes and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were observed. Kaplan-Meier curve analysis was used to evaluate MACCE-free survival rate. Cox proportional hazard model was used to identify risk factors of mid-term MACCE. 38 and 103 patients received only DCB or DES therapy in this study. There were no significant differences in demographic characteristics and laboratory parameters between two groups. The in-hospital MACCE rate of DES group was numerically higher than that of DCB group (9.7% vs. 5.3%), but the difference was not statistically significant (P=0.4). The incidence of MACCE after patients' discharge was significantly higher in DES group (22% vs. 5.3%, P=0.02) during a median follow-up time of 20 months. After multivariable Cox proportional hazard analysis, DCB therapy was independently associated with the reduced risk of mid-term MACCE (hazard ratio=0.21, 95% CI 0.06-0.91, P =0.04). For patients with MVCAD undergoing one-stop HCR, DCB therapy may be the optimal revascularization strategy for non-small non-LAD coronary artery lesions with significantly lower rate of mid-term MACCE.

Loeys-Dietz syndrome (LDS) is an inherited connective tissue disorder associated with aortic root enlargement and risk of thoracic aortic dissection (AD). Genetic examination is essential for diagnosis. Analysis of clinical data on cardiovascular involvement and management of LDS patients. The study included carriers of LDS-associated genetic variants, identified between 2012 and 2022. Assessment of cardiovascular involvement was based on echocardiography and computed tomography angiography with quantitative assessment of arterial tortuosity. Involvement of other systems was also evaluated. We noted major cardiovascular events, including aortic events, defined as AD, elective aortic surgery or otherwise unexplained sudden death. 34 patients from 15 families were included, five identified variants were novel. Probands' mean age was 41 years. Cardiovascular abnormalities, aortic involvement, aortic tortuosity and tortuosity of cervical arteries were present in 79, 71, 68 and 100% of carriers, respectively. First aortic events (9 A-type AD, 6 elective thoracic aortic surgeries, and one sudden death) occurred in 16 (47%) patients at median age of 35 years. The youngest age at AD was 16 years, and 7 years at elective aneurysm repair. Second and third aortic event occurred in 9 and 4 patients, respectively. 8 patients (24%) experienced other major cardiovascular events. Aortic event-free survival was shorter in presence of skin striae (p=0.03), tended to be shorter in presence of marfanoid features (p=0.06), and longer with TGFB2 variants (p=0.06). LDS is associated with high burden of cardiovascular complications at young age.