INTRODUCTION: Elderly patients with transthyretin amyloid cardiomyopathy (ATTR-CM) remain underrepresented in clinical trials. This study aimed to evaluate the effectiveness of tafamidis 61 mg in patients with ATTR-CM across different age groups. MATERIAL AND METHODS: Patients with ATTR-CM treated with tafamidis 61 mg were stratified into age groups: < 75, 75–85, > 85 years. Clinical and echocardiographic data were collected at baseline and follow-up. The primary outcome – cardiovascular-related hospitalization and cardiovascular death – was assessed using Kaplan–Meier analysis. RESULTS: A total of 89 patients with ATTR-CM were included: < 75 (n = 23), 75–85 (n = 40), and > 85 years (n = 26). Hereditary ATTR-CM was more prevalent in younger patients (p < 0.001). Older patients (≥ 75) were more often in NYHA class II/III (p = 0.009), required higher diuretic doses (p < 0.001), and had higher NT-proBNP (p = 0.002). At baseline, patients ≥ 75 years had greater maximal wall thickness (p < 0.001) and left ventricular mass (p = 0.034); global longitudinal strain was most impaired in those > 85 years (p = 0.039). Over a mean follow-up time of 27.4 ± 19.3 months, tafamidis treatment in patients > 85 years was associated with a greater reduction in NT-proBNP (p = 0.041) and in diuretic doses compared to those < 75 years (p = 0.044). No significant changes were observed in NYHA class, Kansas City Cardiomyopathy Questionnaire scores, or echocardiographic parameters. The composite outcome of cardiovascular-related hospitalization and cardiovascular death did not differ significantly among age groups (Log-Rank 5.71, p = 0.06). CONCLUSIONS: This study underscores the benefits of tafamidis in elderly patients, including those aged > 85 years, and supports its use across all age groups to improve cardiovascular outcomes in ATTR-CM.
Leadless cardiac pacemakers (LPs) represent a significant advancement in cardiac pacing by eliminating the risks associated with traditional transvenous devices. Although single-chamber LPs have been in clinical use, the recent development of dual-chamber systems, such as AVEIR DR, offers synchronized atrial and ventricular pacing without the complications associated with transvenous hardware. Despite promising results, the widespread clinical adoption of dual-chamber LPs in Poland remains hindered by regulatory and reimbursement challenges. Although patients have access to single-chamber LPs, an unmet clinical need for dual-chamber LPs persists. Addressing this barrier is essential because dual-chamber LPs may optimize treatment by replacing two separate hospitalizations and implantations with a single procedure, thereby reducing the number of interventions and patient risk while lowering healthcare costs. This approach offers both clinical and economic benefits by improving efficiency and resource utilization in the healthcare system. This paper presents national experts’ recommendations, supported by clinical research findings, on the use of dual-chamber LPs and solutions to increase their availability to patients in Poland.
INTRODUCTION: The optimal revascularization strategy for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease remains uncertain. This meta-analysis aimed to evaluate the impact of one-time versus staged multivessel percutaneous coronary intervention (PCI) on clinical outcomes. MATERIAL AND METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and cohort studies comparing one-time and staged PCI in NSTE-ACS patients with multivessel disease from January 1, 2000 to June 4, 2026. Study quality was assessed, data were extracted independently by two reviewers, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using R software and the meta package. RESULTS: Ten studies involving 6,749 patients (4,235 one-time PCI; 2,514 staged PCI) were included. In randomized trials, one-time PCI significantly reduced repeat revascularization (RR = 0.71, 95% CI 0.51–0.98, p = 0.037) versus staged PCI, with no differences in mortality or recurrent myocardial infarction. Cohort studies and the pooled analysis showed no significant differences across outcomes. CONCLUSIONS: For NSTE-ACS patients with multivessel disease, multivessel revascularization in a single procedure may reduce repeat revascularization compared with staged PCI, but the evidence remains limited.
