Myocardial Infarction In Poland Research Articles

Indirect impact of the war in Ukraine on primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in Poland.

The Russian invasion of Ukraine in February 2022 resulted in displacement of approximately 12.5 million refugees to adjacent countries, including Poland, which may have strained health care service delivery. Using the ST‑segment elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invasion of Ukraine has indirectly impacted delivery of acute cardiovascular care in Poland. We analyzed all adult patients undergoing percutaneous coronary interventions (PCIs) for STEMI across Poland between February 25, 2017 and May 24, 2022. The investigated health care centers were allocated to regions below and over 100 km from the Polish-Ukrainian border. Mixed‑effect generalized linear regression models with random effects per hospital were used to explore the associations between the war in Ukraine and several parameters, and whether these associations differed across the regions below and over 100 km from the border. A total of 90 115 procedures were included in the analysis. The average number of procedures per month was similar to the predicted volume for centers over 100 km from the border, while it was higher than expected (by an estimated median of 15 [interquartile range, 11-19]) for the region below 100 km from the border. There was no difference in adjusted fatality rate or quality of care outcomes for pre- and during‑war time in both regions, with no evidence of a difference‑in‑difference across the regions. Following the Russian invasion of Ukraine, there was only a modest and temporary increase in the number of primary PCIs, predominantly in the centers situated within 100 km of the Polish-Ukrainian border, although no significant impact on in‑hospital fatality rate was found.

Comparison of inpatient and outpatient cardiac rehabilitation following myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) following myocardial infarction (MI) improves prognosis. Models of second phase CR differ across countries. The aim of the study was to compare outcomes in MI survivors participating in outpatient and inpatient CR programmes. Methods We included all patients hospitalized due to acute MI in Poland between October 2017 and December 2018 (n=96634). Among them 4411 patients were referred to and commenced outpatient CR, whereas 11626 patients started inpatient CR within 30 days following discharge. All the patients were the subject of prospective follow-up. The primary endpoint was defined as death from any cause. Results The mean follow-up was 332.8±128.1 days. Younger age, male sex, and a cancer in the history were related to higher probability, whereas diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, and myocardial revascularization were related to lower probability of participation in the outpatient CR. Participation in outpatient CR was related to the risk of all-cause mortality both in univariable (hazard ratio [95% confidence intervals] 0.37 [0.26-0.51]) and multivariable analysis (0.53 [0.38-0.74]). Participation in the outpatient CR was also related to the lower risk of death or MI or stroke (0.57 [0.48-0.67] and 0.72 [0.61-0.84]) and a lower risk of death or hospitalization due to cardiovascular reasons: 0.78 (0.73-0.84) and 0.85 (0.80-0.91) for the univariable and multivariable analyses respectively. The analysis of propensity score matched groups confirmed the results. Conclusion Outpatient CR following MI may be related to improved prognosis compared to the inpatient programme.

Management and predictors of clinical events in 75 686 patients with acute myocardial infarction

Although mortality in patients with acute myocardial infarction (MI) has decreased substantially over the last few decades in many countries, MI remains a major threat to public health. To assess the number and outcomes of patients hospitalized for acute MI in Poland in 2018 as well as proportions of patients participating in cardiac rehabilitation and undergoing invasive cardiac procedures following discharge. We used public databases. We included all patients hospitalized for acute MI in Poland in 2018 and assessed event-free survival along with uptake of invasive cardiac procedures, cardiac rehabilitation, and consultations with cardiologists. A total of 75868 patients (mean age, 68.8 years) were hospitalized for acute MI in Poland in 2018 (the admission rate, 197.0 per 100000 inhabitants). In-hospital mortality was 8.4%, while one-year mortality was 17.3% (one-year post-discharge mortality was 9.8%). Approximately 75% and 96% of discharged patients consulted a general practitioner, whereas 12% and 62% consulted a cardiologist, 5% and 19% underwent percutaneous coronary intervention, 0.6% and 2.9% un-derwent coronary artery bypass grafting, while 0.04% and 1.9% had an implantable cardioverter defibrillator implanted within 30 days and 365 days following discharge. The participation rate in cardiac rehabilitation within the first 14 days following discharge was 11%, within the first 30 days was 19%, and within 365 days was 35%. In-hospital and post-discharge mortality is still high in Poland. The access to cardiac consultations and cardiac rehabilitation following MI is insufficient. There is considerable potential for a further decrease in mortality in patients suffering from MI in Poland.

Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors.

Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause. The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44-4.88]), consultation with a cardiologist (7.32 [6.83-7.84]), implantable cardioverter-defibrillator (1.40 [1.22-1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22-2.03]) but lower odds of emergency (0.88 [0.79-0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83-0.93]) and coronary artery bypass grafting (0.82 [0.71-0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% (P<0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% (P<0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures. Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.

Improved coordination of care after acute myocardial infarction in Poland since 2017: Promising early results

A new model of complex patient care after acute myocardial infarction (AMI) has been in operation in Poland since late 2017, comprising invasive treatment, cardiac rehabilitation and scheduled outpatient follow-up. Its stated objectives are to improve secondary prevention measures, quality of care and long-term health outcomes in AMI-patients. The model implements all key aspects of post-MI care recommended by the European Society of Cardiology (ESC), representing the first nation-wide model of structured and comprehensive post-MI care that closely follows ESC guidelines. The aim of this paper is to describe the background of this reform, its content and implementation as well as to assess its results. Early outcomes seem promising, with significantly lower mortality rate and lower risk of serious cardiological events in patients participating in the new model of care compared to patients who were not included. A comprehensive assessment of the reform will require further clinical data, covering a larger population and a longer period of time, as well as a holistic analysis of the programme in its wider context, taking into account potential benefits and cost-effectiveness of improved primary prevention implemented outside of this model.

Decline in the number of coronary angiography and percutaneous coronary intervention procedures in patients with acute myocardial infarction in Poland during the coronavirus disease 2019 pandemic

Decline in the number of coronary angiography and percutaneous coronary intervention procedures in patients with acute myocardial infarction in Poland during the coronavirus disease 2019 pandemic

Medical emergency team interventions in patients with ST-segment elevation myocardial infarction in Poland in 2018.

The National Emergency Medical Services Management Support System, a unique information and communication technology system, was developed to reduce the burden of ST-segment elevation myocardial infarction (STEMI) in Poland. According to the European Society of Cardiology guidelines, medical emergency teams (METs) should diagnose STEMI using electrocardiogram (ECG) transmission and apply dual antiplatelet therapy (DAPT) as a pivotal treatment. This study aimed to analyze MET interventions in patients with STEMI and assess regional differences in the management in Poland. Using ambulance call reports, we retrospectively analyzed MET interventions due to conditions classified as I21 (acute myocardial infarction; according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), which were performed in Poland between January 1, 2018 and December 31, 2018. In 2018, METs conducted 16 807 interventions classified as I21, which accounted for 0.5% of all MET interventions in Poland in that year. Most interventions were conducted in the Mazovia Province (13.4%; P<0.001), and the lowest number was reported in the Podlasie Province (2.5%). A 12‑lead ECG was performed during 98.6% of interventions, and ECG transmission in 37.49%: most often in the Mazovia Province (59.62%; P<0.001), and least often in the Lublin Province (13.8%). In 72.12% of interventions, DAPT was applied: clopidogrel was the P2Y12 inhibitor used in 49.68% of interventions, and ticagrelor in 25.14% (P<0.001). A P2Y12 inhibitor was most often used in the Wielkopolska Province (98.4%), and least often in the Silesia Province (40.34%). Significant differences in the implementation of the European Society of Cardiology guidelines regarding ECG transmission and DAPT were observed between particular provinces in Poland.

P1743Assessment of quality of care of patients with ST-segment elevation myocardial infarction in Poland

Abstract Introduction 2017 ESC Guidelines for the management of ST-elevation myocardial infarction (STEMI) patients have called for the assessment of the quality of care to establish measurable quality indicators in order to ensure that every patient with STEMI receives the best possible care. We investigated the quality indicators of health care services in Poland provided to STEMI patients. Methods The Polish Registry of Acute Coronary Syndromes (PL-ACS) is an ongoing, nationwide, multicenter, prospective, observational study of consecutively hospitalized patients with the whole spectrum of ACS in Poland. For the purpose of assessing quality indicators, we included 8,279 patients from the PL-ACS Registry hospitalized with STEMI between January 1 and December 31, 2018. Results All emergency medical services (EMS) are equipped with ECG/defibrillators. 408 of 8,279 patients (4.9%) arrived at PCI center by self-transport, 4,791 patients (57.9%) patients arrived at PCI center by direct EMS transport, and 2,900 patients (37.2%) were transferred from non-PCI facilities. Whilst 95.1% of STEMI patients arriving in the first 12 hours received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various STEMI pathways). 7,807 patients (94.3%) underwent PCI as a mode of primary reperfusion strategy. The median left ventricular ejection fraction (LVEF) was 46% and was assessed before discharge in 86.0% of patients. 489 of 8,279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two STEMI patient is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the PL-ACS Registry. Figure 1 Conclusions The results of this study identified areas of healthcare systems that require solid improvement. These include prehospital ECG decision strategy, direct transport to PCI center, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. More importantly, we recognized an urgent need for the initiation of recording quality indicators associated with patient-reported outcomes.

Adherence to guidelines for pharmacological treatment of young adults with myocardial infarction in Poland: Data from Polish Registry of Acute Coronary Syndromes (PL-ACS).

Myocardial infarction (MI) in young adults accounts for up to 10% of all cases. Regarding life expectancy and professional activity, it is extremely important to restore and maintain young patients' full performance. Therefore, secondary prevention is especially vital in this group of patients. The paper focuses on the analysis of pharmacotherapy in young MI patients in Poland, assessing disparities between the European Society of Cardiology guidelines and clinical practice, and regional differences among the provinces. The analysis was conducted using the data from a nationwide, observational, multicentre, prospective study-the Polish Registry of Acute Coronary Syndromes (PL-ACS). The data were collected from patients ≤45years old with MI who were hospitalized in the period 2010-2014. A retrospective study included 6367 MI patients. They constituted 3.9% of all the patients with MI in Poland. Despite the fact that during hospitalization regional differences were observed in case of acetylsalicylic acid (range 70.3%-93.8%), β-blockers (range 50.0%-79.6%), statins (range 53.4%-85.7%) and angiotensin-converting enzyme inhibitors (range 46.9%-75.0%), the majority of patients received the drugs according to the guidelines. Regional differences found at discharge also regarded those medications, but the range of observed variations was smaller. On average, three-quarter of patients received guideline-recommended medications. Still, in some provinces, almost a quarter of patients were administered those medications only at discharge. In the study population, there were significant differences between the provinces regarding pharmacotherapy during hospitalization, which concerned major groups of medications. However, pharmacotherapy indicated at discharge revealed fewer regional differences and adhered to guideline recommendations to a greater extent. Nevertheless, there is still some room for improvement, especially with regard to pharmacotherapy during hospitalization.

Treatment and outcomes of patients under 40 years of age with acute myocardial infarction in Poland in 2009-2013: an analysis from the PL‑ACS registry.

INTRODUCTION Patients under the age of 40 years represent from 1% to 6% of all patients with acute myocardial infarction (AMI). OBJECTIVES We aimed to analyze the recent trends in the clinical presentation, treatment, and both the in‑hospital and 12‑month outcomes of patients under 40 years of age with ST‑segment elevation myocardial infarction (STEMI) and non‑STEMI (NSTEMI), treated from 2009 to 2013. PATIENTS AND METHODS The study included 1639 young patients with AMI under the age of 40 years included in the PL‑ACS registry (1.3% of all patients with AMI). Trends in the period from 2009 to 2010 (643 patients) and from 2012 to 2013 (676 patients) were analyzed. RESULTS The percentage of admissions for STEMI decreased (71.7% vs 63.9%; P = 0.002), while that of admissions for NSTEMI increased (28.3% vs 36.1%; P = 0.002) over the years. There was no difference in the in‑hospital mortality (1.7% vs 1.6%; P = 1.0). The percentage of patients treated invasively increased from 90.7% in the period 2009-2010 to 95.7% in the period 2012-2013 (P = 0.0003). There was no difference between the groups in the incidence of death (2.5% vs 2.8%; P = 0.72) or the rate of the composite endpoint of death, recurrent AMI, or stroke within 1 year of the index hospitalization (5.3% vs 5.6%, P = 0.80). CONCLUSIONS There was no significant difference in the in‑hospital and 12‑month outcomes between the patients under 40 years of age with STEMI and NSTEMI hospitalized in the years 2009-2010 and those treated in the years 2012-2013. The relative percentage of patients with NSTEMI and those treated invasively increased significantly over the years.

Status of marginal periodontal tissues in patients after myocardial infarction in Poland

Status of marginal periodontal tissues in patients after myocardial infarction in Poland

Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012--nationwide AMI-PL database.

Nationwide data on acute myocardial infarction (AMI) are available for some Western but not for Central and Eastern European countries. We performed a study on nationwide data of all Polish AMI patients in 2009-2012 to assess incidence, quality of care, and cardiovascular events during 1 year following AMI. The database of the only public, obligatory health insurer in Poland (National Health Fund) together with data from the Central Statistical Office were used. AMI cases were selected based on primary diagnosis ICD-10 codes I21-I22. For years 2009-2012, index hospitalisations (n = 311,813) in a given year and death records were analysed. Additionally, data on hospitalisations, procedures and deaths during 1 year follow-up were obtained for 2009. Age-adjusted incidence of AMI in Poland in 2009 was 196 cases per 100,000 population (176 per 100,000 were hospitalised), with a decreasing trend over time. The incidence was 2.5 times higher in men than in women. The median age was 63 years in men and 74 years in women. The proportion of ST elevation myocardial infarction (STEMI) decreased from 59% to 48% in 2012, and the proportion of patients receiving invasive treatment increased from 72% to 81%. Age-adjusted case fatality rate was equal in women and men. In 2009, the number of patients with AMI was 75,054 (61% men, 39% women) and 83% of them were treated in cardiology units. Invasive strategy was used in 77% of patients with STEMI and 66% of those with non-STEMI, thrombolysis in 1% and coronary artery bypass grafting in 1.9% of patients. Invasive treatment was used less frequently in women and the elderly patients. When all hospitals where a patient was treated until the final discharge were taken into account, in-hospital mortality was 10.5%. The lowest in-hospital mortality was noted among patients treated invasively (6.3%). The total number of readmissions within 1 year following AMI was 84,718, of which 61.9% were due to cardiovascular causes. The most common causes were stable coronary artery disease (27%), heart failure (7.9%), recurrent infarction (7.0%), and unstable angina (6.8%). Within 1 year after AMI, only 22% of patients participated in a cardiac rehabilitation programme. Total 1-year mortality was 19.4% (invasive treatment 12.3%, non-invasive treatment 38.0%). Standards of care and early outcomes in AMI in Poland are similar to Western countries. The major cause of higher mortality due to AMI in the Polish population is a high incidence of AMI, indicating a need for intensification of primary prevention programmes. Secondary prevention is also underused, especially in the field of cardiac rehabilitation.

Oral health in postmenopausal and premenopausal women after myocardial infarction in Poland: a preliminary study.

IntroductionAge and hormonal disorders are recognized factors impacting the periodontium and the prevalence of cardiovascular diseases, but as yet the relationship between these two conditions in postmenopausal (post-M) and premenopausal (pre-M) women in Poland has not been assessed. The aim of this study was to compare the periodontal status in women after myocardial infarction (MI) with women without MI history and to determine risk factors for periodontitis.Material and methodsThe study included 35 women hospitalized due to MI, average age 54.7 ± 9.4 years, and 96 women randomly drawn from the general population, average age 56.1 ± 10.0 years. All women were checked for periodontitis risk factors (education, socioeconomic status, tobacco smoking, stress), and underwent dental examination.ResultsThe lowest number of teeth was found in post-M women after MI (median = 8), whereas pre-M women without MI history had 25 teeth. Edentulousness occurred more frequently in post-M women compared with pre-M women (12.2% vs. 0%), the same was observed for advanced periodontitis (28.4% vs. 21.1%). The severity of periodontitis was highest in the post-M subgroup (more than half demonstrated advanced periodontitis or edentulousness). The most important risk factor for periodontitis, regardless of age, was the level of education. In post-M women the second risk factor was smoking, while in pre-M women negative stress.ConclusionsThe status of oral health in post-M women is unsatisfactory, particularly in those affected by cardiovascular diseases. It is necessary to take preventive and educational measures targeted at these women.

Temporal Trends in the Treatment and Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction in Poland from 2004–2010 (from the Polish Registry of Acute Coronary Syndromes)

The aim of this work was to analyze temporal trends in clinical presentation, treatment methods, and outcomes of patients in Poland with non-ST-segment elevation myocardial infarction (NSTEMI) from 2004 to 2010. A total of 90,153 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2004 to 2010 were analyzed. The main outcome measure was all-cause mortality after 12 months, identified from official mortality records. The percentage of admissions for NSTEMI among all acute coronary syndromes increased from 24% in 2004 to 38% in 2010 (p < 0.0001). From 2004 to 2010, the percentage of invasive treatment for NSTEMI increased significantly, almost threefold, to 83% (p < 0.0001). The frequency of recurrent myocardial infarction and stroke during hospitalization decreased significantly over the years, while the frequency of major bleeding increased. Twelve-month mortality decreased significantly throughout the time period, from 19.1% to 14.5%, but was stable in patients treated invasively and slightly higher in the last years in patients treated noninvasively. The invasive treatment of NSTEMI (relative risk 0.62, 95% confidence interval 0.57 to 0.67, p < 0.0001), together with the pharmacotherapy recommended by the guidelines, had a significant impact on reducing 12-month mortality in a multifactor analysis. In conclusion, the distinct improvement in the short- and long-term prognoses of patients with NSTEMI may be in part the result of the popularization of invasive treatment and the optimization of pharmacotherapy.

Myocardial infarction and angina pectoris in the history of Polish medicine. Part 1. Discovery and understanding of the disease

This review presents the most important achievements associated with the understanding of angina pectoris and myocardial infarction in Poland. The author describes the contribution of physicians living on Polish soil to scientific knowledge in this field. The beginning of Polish interest in cardiac diseases are associated with an eminent medieval physician, Thomas of Wrocław. In Part 1, a history of studies on myocardial infarction ends with establishing the first diagnosis of myocardial infarction as the cause of death in patients with angina in the mid-19th century. While discussing the contribution of Polish physicians to the worldwide knowledge about myocardial infarction, crucial facts associated with understanding of angina pectoris in other countries have been presented. The discovery of the pathomorphological features of ischemic heart disease and its relation to clinical signs or symptoms has been reminded to the readers. Eminent and well or less known Polish forefathers of medicine are recalled, including Adam Christian Thebesius, Józef Chrzczonowicz, Jan Cenner, Andrzej Janikowski, Józef Rompalski, Józef Pawiński and Edward Korczyński.

Comparison of medical care and survival of hospitalized patients with acute myocardial infarction in Poland and the United States

Few studies have evaluated between-country differences in medical care and survival after acute myocardial infarction, and none have compared the US with countries from Eastern Europe. Comparable data from the US (Atherosclerosis Risk in Communities Study [US-ARIC]) and Poland (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project [Pol-MONICA]) were developed. From 1987 through 1993, a total of 3,694 patients were hospitalized with acute myocardial infarction events in the 2 Pol-MONICA communities and 4,801 in the 4 US-ARIC communities. Patients in the US-ARIC were 1.7 times more likely to be treated in a coronary care unit and received cardiac procedures, calcium channel blockers, and thrombolytic agents significantly more often than patients in the Pol-MONICA. The use of antiplatelet agents, nitrates, angiotensin-converting enzyme inhibitors, and β blockade agents was similar in both countries. Case fatality (28-day) rates after hospitalized acute myocardial infarction were nearly identical (men, 7% in Pol-MONICA vs 6% in US-ARIC; women, 9% in Pol-MONICA vs 8% in US-ARIC). However, when fatal coronary heart disease events not associated with a hospitalized myocardial infarction were included, the US-ARIC rates were less than half than those seen in Pol-MONICA. Substantial differences in treatment of hospitalized acute myocardial infarction between countries did not translate into a survival advantage for patients reaching clinical attention. Differences in case severity, arising from the high out-of-hospital coronary death rate in Poland may play an important role in this finding.