BACKGROUND:Contemporary data on pulmonary arterial hypertension (PAH) from Central and Eastern Europe are scarce. AIMS:The aim of this study was to assess clinical characteristics, treatment, survival, and predictors of early improvement and long-term outcomes in newly diagnosed PAH in the BNP-PL database. METHODS:Consecutive patients with newly diagnosed, non-vasoreactive PAH between 2018 and 2023 were included. Changes in 4-strata risk category from diagnosis to the first available follow-up assessment within the first 12 months after diagnosis were analyzed. RESULTS:Among 806 patients, 445 had idiopathic PAH, 176 connective tissue disease-associated PAH, 147 congenital heart disease-associated PAH, and 38 other PAH subtypes. Kaplan-Meier estimated 12-month mortality was 13.5%. During a median follow-up of 16 (8-33) months, mortality was highest in connective tissue disease-associated PAH and lowest in congenital heart disease-associated PAH. First-year clinical improvement occurred in 45.8%. Improvement rates were 34.8% with upfront monotherapy, 49.2% with dual therapy, and 70.5% with triple therapy (P <0.001). After adjustment for baseline 4-strata risk, more initial PAH-specific drugs and fewer cardiovascular comorbidities were associated with clinical improvement. The baseline 4-strata model better discriminated 12-month mortality than the 3-strata model (area under the curve 0.73 vs. 0.63; P = 0.004). Among first-year survivors, worsening risk category, higher baseline risk, and PAH-related unplanned hospitalization within the first year independently predicted long-term mortality. CONCLUSIONS:Early combination therapy and fewer cardiovascular comorbidities were associated with greater early clinical improvement after adjustment for baseline 4-strata risk category. Baseline mortality risk, first-year change in risk category, and unplanned hospitalization were associated with subsequent mortality.
BACKGROUND:Whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTO percutaneous coronary intervention (PCI) efficacy or a distinct procedural profile remains uncertain. AIMS:To compare acute outcomes, strategy, and treatment pattern between ISR-CTO and de novo CTO. METHODS:We performed a retrospective procedure-level analysis of a prospectively maintained three-center CTO PCI registry from Türkiye, including consecutive procedures between January 2019 and February 2026. The primary endpoint was procedural success, defined as technical success without in-hospital major procedural complications. Technical success was final TIMI 3 flow with residual stenosis < 30%. Major procedural complications included death, stroke, emergency repeat PCI or coronary artery bypass grafting (CABG), donor-vessel complication, and coronary or collateral perforation requiring active treatment. Multivariable logistic regression and prespecified sensitivity analyses were performed. RESULTS:Among 2375 CTO PCI procedures, 296 (12.5%) involved ISR-CTO. Technical success was 92.9% in ISR-CTO and 91.7% in de novo CTO (P = 0.49). Procedural success was 90.2% and 89.0% (P = 0.55), and major procedural complications were similar (3.4% vs. 3.9%, P = 0.66). After adjustment, ISR-CTO was not associated with lower technical success (OR, 1.26; 95% CI, 0.77-2.05), lower procedural success (OR, 1.20; 95% CI, 0.79-1.83), or higher complication risk (OR, 0.84; 95% CI, 0.43-1.66). ISR-CTO was associated with less actual retrograde involvement, greater IVUS/DCB use, and a lower observed DES implantation rate. CONCLUSIONS:ISR-CTO showed acute procedural results comparable to de novo CTO in this selected multicenter cohort. Its main differences were procedural and treatment-related, including less actual retrograde involvement and different IVUS/DCB/DES use.
