Objectives:The aim of the study was to comprehensively characterize the population of hypertrophic cardiomyopathy (HCM) patients in Poland in 2016-2021, including the analysis of annual incidence, prevalence, comorbidities, and therapeutic paths. Methods:A population-based cross-sectional study was conducted using data from the Polish National Health Fund database. The analysis included a registered annual incidence and prevalence rates, mortality, prognosis, and data on patients pathways in the healthcare system. Results:In 2016, the registered annual incidence of HCM diagnosis in Poland was 1,494 cases (3.89/100,000), decreasing to 808 cases (2.11/100,000) in 2021. Despite the decline in new diagnoses, the registered prevalence of HCM increased from 13,271 cases (34.53/100,000) in 2016 to 13,880 cases (36.23/100,000) in 2021, indicating improved patient survival. Annual mortality rose from 824 deaths (2.14/100,000) in 2016 to 1,022 deaths (2.67/100,000) in 2021, with the highest mortality observed in older adults (60+ years). Conclusion:The study highlights significant underdiagnosis of HCM in Poland. Mortality in HCM population remains high, underscoring the need for improvement in earlier detection and comprehensive care strategies in Polish healthcare system.

AIMS:Accurate stratification of mortality risk is essential for management of chronic coronary syndromes (CCS), but existing models focus primarily on short-term outcomes and acute settings. We aimed to develop and validate a machine learning model (ISCHEMIA-PREDICT) for cardiovascular and all-cause death risk in CCS patients. METHODS AND RESULTS:Machine learning analysis of the ISCHEMIA randomized controlled trial (median follow-up 3.2 years) with trial and registry validation. The development cohort comprised 5179 CCS patients; external validation used a 23 303 patient multicentre registry (median follow-up 7.4 years). ISCHEMIA-PREDICT combined the glomerular filtration rate, exercise-induced ST-segment depression, exercise duration, systolic blood pressure, multivessel CAD, and invasive- vs. conservative-treatment strategy. Model discrimination was high for both cardiovascular [area under the curve (AUC) 0.94; 95% CI 0.92-0.96] and all-cause (AUC 0.94; 0.91-0.96) mortality and remained robust in registry-based external validation for all-cause mortality (AUC 0.82; 0.81-0.84). Cardiovascular mortality differed by 6.0% between highest and lowest quartiles (7.10 vs. 1.10%; hazard ratio 6.65; 3.15-14.03). CONCLUSION:The ISCHEMIA-PREDICT score provides a practical tool to stratify cardiovascular and all-cause mortality among CCS patients, enabling risk-guided clinical decision-making. REGISTRATION:ISCHEMIA ClinicalTrials.gov number, NCT01471522. LAY SUMMARY:We created and validated ISCHEMIA-PREDICT, a machine learning-based score using six routine clinical measures to estimate the risk of cardiovascular and all-cause death in people with chronic coronary syndrome. KEY FINDINGS:What we did and found: Using the randomized ISCHEMIA trial (5179 patients), we built a risk score from routinely available data-glomerular filtration rate, ST-segment depression and exercise duration on a stress test, systolic blood pressure, multivessel coronary disease, and initial treatment strategy (invasive vs. conservative). The score clearly separated lower- from higher-risk patients and showed strong discrimination. Its performance for all-cause death was confirmed in an independent, contemporary multicentre registry of over 23 000 patients with long-term follow-up. Why it matters for patients and clinicians: Because it relies on familiar information collected in everyday practice, ISCHEMIA-PREDICT can help clinicians quickly gauge mortality risk in chronic coronary syndrome patients and tailor care accordingly-supporting intensified medical therapy and consideration of invasive management in those at highest risk. A web calculator enables point-of-care use and risk-guided decision-making.

BACKGROUND:Transcatheter mitral edge-to-edge repair (TEER) is an effective and safe therapeutic option for patients with severe mitral regurgitation (MR) and may be used in the treatment of both primary and secondary MR. AIMS:To provide insights into patients' characteristics, in-hospital procedural outcomes, and 1-year follow-up for 1204 patients with severe MR treated with TEER in Poland. METHODS:A comprehensive, all-comers, administrative database that covers the whole population of Poland was searched for all reimbursed TEER procedures performed since 2019. Electronic health records provided details regarding baseline study group characteristics as well as the in-hospital and 1-year outcomes. RESULTS:The in-hospital mortality was 3.2% with no difference between sexes. Blood transfusion was required in 7.8% of patients, more frequently in women (11.1% vs. 6.1%; P = 0.004). Patients with atrial fibrillation had a higher rate of in-hospital heart failure (HF) in New York Heart Association functional class II-IV vs. I (66.8% vs. 42.5%; P < 0.001). Mean follow-up was 336.7 days. The mortality rate was 13.9% and was comparable between males and females and between patients with and without atrial fibrillation. 54.5% of patients required a HF hospitalization and 65.0% a cardiovascular hospitalization. Mortality was comparable to other European registries, but rates of HF hospitalization were higher in the Polish population. CONCLUSIONS:The Polish TEER registry provides real-world data on transcatheter edge-to-edge repair procedures, demonstrating outcomes comparable to other European registries despite a higher-risk patient population.

BACKGROUND:Impella is increasingly used as mechanical circulatory support (MCS) during high-risk percutaneous coronary interventions (HR-PCI). Registry-based data provide insights into the efficacy and safety of Impella-assisted HR-PCI. AIMS:We aimed to evaluate 1-year outcomes of Impella-assisted HR-PCI compared to HR-PCI without MCS. METHODS:One hundred and thirty-eight patients undergoing Impella-assisted PCI, included in the IMPELLA-PL registry, were propensity score-matched with controls from the retrospective CardioSilesia registry who underwent HR-PCI without MCS. Study endpoints included 1-year post-discharge all-cause mortality, myocardial infarction (MI), stroke, rehospitalization for heart failure (HF), and repeat coronary revascularization. RESULTS:Clinical and angiographic characteristics were comparable in both groups, with higher rates of dyslipidemia (78.3% vs. 37.7%, p < 0.001), chronic kidney disease (39.9% vs. 16.7%, p < 0.001), and peripheral artery disease (34.1% vs. 8.0%, p < 0.001) in the IMPELLA-PL cohort. Intravascular ultrasound was more frequently used in the Impella-supported patients (44.2% vs. 25.4%, p = 0.002), while staged revascularization was more common among controls (30.4% vs. 15.9%, p = 0.007). At 1 year, rates of post-discharge all-cause mortality, stroke, and repeat coronary revascularization were similar in both groups. MI was less frequent in the IMPELLA-PL cohort (1.4% vs. 10.9%, p = 0.003), alongside a trend toward lower incidence of rehospitalizations for HF (9.4% vs. 18.1%, p = 0.055). CONCLUSIONS:Despite an unfavorable cardiovascular risk profile, patients who underwent Impella-assisted HR-PCI had similar 1-year post-discharge survival, with a lower rate of MI, compared to propensity score-matched controls who underwent HR-PCI without MCS. Impella may improve HR-PCI outcomes in selected patients, but further randomized controlled trials are required to confirm this finding.

BACKGROUND:Transcatheter aortic valve implantation (TAVI) has become a cornerstone in the treatment of severe aortic stenosis, with expanding indications for lower-risk patients. However, real-world data, especially regarding post-discharge outcomes, from multicenter registries are scarce but needed. AIMS:To evaluate the in-hospital and mid-term outcomes of patients undergoing TAVI in all Polish centers between 2019 and 2023. MATERIAL AND METHODS:Clinical data were extracted from the Polish E-Health database of the National Health Fund. Procedures were identified using specific procedural codes. Long-term outcomes were established based on National Health Fund data, with outcome occurrence derived from the primary/secondary diagnoses for admissions during the one-year duration of follow-up, with a censoring date of December 31, 2023. RESULTS:Between 2019 and 2023, 11 351 TAVIs were performed in Poland. The in-hospital mortality rate was 2.9%. Of the total group, 7860 underwent the procedure between 2019 and 2022, providing a one-year follow-up to the censoring date. In those patients, the overall all-cause 1-year mortality was 12.7%, with higher rates among patients with atrial fibrillation, heart failure, and among men. Myocardial infarction occurred in 1.2%, stroke in 2.3%, and 23.3% patients required hospitalization for heart failure. The 12-month rate of cardiac implantable electronic device implantation was 11.8%. CONCLUSIONS:This study provides the first real-world TAVI outcomes in Polish patients based on the national, multicenter registry, showing an in-hospital mortality of 2.9% and a 12-month all-cause mortality of 12.7%. The 1-year outcomes of patients treated with TAVI in Poland are comparable to international registries.

Background: Models of second-phase cardiac rehabilitation (CR) following myocardial infarction (MI) differ across countries. The aim of this study was to compare outcomes in MI survivors participating in outpatient and inpatient CR programs. Methods: All patients hospitalized for acute MI in Poland between October 2017 and December 2018 (n = 96,634) were included in the study. Among them, 4411 patients were referred to and commenced outpatient CR, whereas 11,626 patients started inpatient CR within 30 days following discharge. Results: The mean follow-up period was 332.8 ± 128.1 days. Younger age, male sex, and a history of cancer were associated with a higher probability of participating in outpatient CR, whereas diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, ST-elevation MI, and myocardial revascularization were associated with a lower likelihood of outpatient CR participation. Participation in outpatient CR was linked to a reduced risk of all-cause mortality, in both univariable (hazard ratio [95% confidence interval]: 0.37 [0.26-0.51]) and multivariable analyses (0.53 [0.38-0.74]). Outpatient CR was also associated with a lower risk of death, MI, or stroke (0.57 [0.48-0.67] in univariable analysis and 0.72 [0.61-0.84] in multivariable analysis), as well as a lower risk of death or cardiovascular hospitalization (0.78 [0.73-0.84] and 0.85 [0.80-0.91], respectively). Conclusions: Outpatient CR following MI tends to occur alongside a better prognosis compared to inpatient programs.

Abstract Aims Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. Increased Lp(a) concentration >30 mg/dl may cause faster atherosclerosis. There is a need to characterize further the clinical phenotypes in patients at risk for ASVD with high Lp(a) levels. Material The Zabrze-Lip(a)R Registry was created on the basis of data from 2,001 patients with high- and very high cardiovascular risk treated in a tertiary hospital, and the Registry patients will be followed for many years. Mortality and cardiovascular events, such as known death, MI, and stroke, will be assessed. Results The median Lp(a) concentration in the entire population was 6.6 mg/dl (mean 14.3 ± 19.4 mg/dl). Preliminary results of the study group showed that 540 (27%) patients had elevated Lp(a) levels above 30 mg/dl, mainly in patients with established ASCVD after MI and/or coronary revascularization. Patients with elevated Lp(a) levels are older and have higher hematocrit and NT-proBNP and CRP levels. Conclusions Extensive observational studies are essential for further work that objectively collects information on the risks associated with Lp(a) values and cardiovascular disease. Additionally, developing a deeper understanding of the impact of Lp(a) on prognosis will be valuable in how Lp(a) interacts with other established risk factors in improving cardiovascular risk prediction.Distribution of Lp(a) concentrationsComparison of pts with different Lp(a)

Introduction: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Increased Lp(a) concentration > 30 mg/dl (75 nmol/l) and especially >50 mg/dl (125 nmol/l) may cause faster atherosclerosis, being an important and underdiagnosed residual cardiovascular risk factor. Thus, there is a need to characterize further the clinical phenotypes in patients at risk for ASCVD with high Lp(a) levels now and during follow-up, while also looking for the possible impact of geographical differences. Material and methods: The Zabrze Lipoprotein(a) Registry (Zabrze-Lip(a)R) was founded on the basis of data from 2,001 consecutive patients with very high cardiovascular risk treated in a tertiary hospital. The registry patients will be followed for at least 5 years with the possibility of extending this period as an open label study. All-cause and cause-specific mortality, hospitalizations, and cardiovascular events, such as myocardial infarction (MI) and stroke, will be assessed. Results: The mean age of patients was 66.4 years (females 37.1%). The median Lp(a) concentration in the entire population was 6.6 mg/dl (16.5 nmol/l) (mean: 14.3 +/- 19.4 mg/dl). 540 (27%) patients had elevated Lp(a) levels above 30 mg/dl (75 nmol/l); they were significantly older (68.8 vs. 66.3 years; p = 0.04), had significantly lower hemoglobin and hematocrit, and higher platelet count and levels of NT-proBNP and C-reactive protein. The prevalence of elevated Lp(a) > 30 mg/dl (75 nmol/l) concentrations was very high in patients with a chronic coronary syndrome (CCS) (52.2% (282/540) vs. 41.5% (607/1461); p < 0.001), in patients undergoing PCI during hospitalization (23.9 vs. 19%; p = 0.01), and in patients with previous MI (20.6% vs. 14.9%; p = 0.0022). In the multivariable analysis, the independent predictors of elevated Lp(a) > 30 mg/dl (75 nmol/l) were only lower Hb values (OR = 0.925; 95% CI: 0.874-0.978; p = 0.006) and higher platelet count (1.002; 95%CI: 1.000-1.003; p < 0.02). Conclusions: In Poland, the largest representative of Central and Eastern European countries, 27% of patients at very high cardiovascular risk with established ASCVD experience additional risk related to an elevated Lp(a) level, with every second patient having CCS. Interestingly, only two factors were significantly related to elevated Lp(a) levels: lower Hb values and higher platelet count. However, the clinical relevance of these results needs confirmation.

Background: The diagnosis and management of cardiomyopathies (CMs) are subject to regional variations but no study to date has systematically evaluated the clinical pathways of patients with CMs. Aims: We aimed to assess the management pathway of CM patients in Poland. Methods: This population-based cross-sectional study was conducted based on data from 2016 to 2021 obtained from the national healthcare provider using ICD10 codes to identify CM patients. The treatment pathways of CM patients, defined as the sequence of visits to the public healthcare system and categorized as urgent hospitalization (UH) for disease exacerbation, elective hospitalization (EH), tertiary outpatient medical care (TMC), primary outpatient healthcare (general practice [GP]) were analyzed. Results: Between 2016 and 2021, 65 383 CM patients were analyzed (mean age: 60 years, 65.4% men). Total healthcare services provided to these patients involved hospitalization (47.2%), TMC (16.5%), and GP (27.5%). The first registration CM diagnosis was made on an inpatient basis in 93.4% of patients (UH: 68.1%; EH: 25.1%). The mortality rate during the analyzed period was 39.8% for the total CM population, 43.9% for patients who were registered in the system only once (47% of all subjects), and 65.4% for patients with a Charlson Comorbidity Index >= 5. Conclusions: The diagnosis of CMs in Poland is established very late mainly during hospitalization for exacerbation of the disease. This may have an impact on the poor prognosis of CM patients especially those with a high comorbidity burden. This study highlights the urgent need for improvement in CM management in Poland.

Background: There are no data on the characteristics and outcomes for patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction diagnosed according to the universal definition and classification of HF. Aims: We used the universal HF definition to compare baseline characteristics, hospital readmission and mortality rates in individuals with HFrEF, HFmrEF, and HFpEF diagnosed retrospectively. Results: The study was designed as a single -center retrospective analysis of all consecutive 40732 hospital admissions between 2013 and 2021 in a tertiary department of cardiology. All patients with HF, defined according to the universal definition and classification of HF, were identified. The study included 8471 patients with a mean age of 65.1 (12.8) years, of whom 2823 (33.3%) were females. Most individuals had a prior diagnosis of HF (76.3%) and elevated N -terminal pro -B -type natriuretic peptide levels (99.0%) with a median of 1548 (629-3786) pg/ml. Mean ejection fraction (EF) was 36.2 (14.9)%. The median follow-up was 39.1 (18.1-70.5) months. The most frequent type of HF was HFrEF (n = 4947; 58.4%), followed by HFpEF (n = 1138; 28.2%) and HFmrEF (n = 2386; 13.4%). Urgent HF readmissions and all -cause deaths were highest in HFrEF (40.8% and 42.7%), followed by HFmrEF (25.4% and 31.5%) and HFpEF (15.2% and 23.8%, respectively). Conclusions: The highest rates of urgent HF readmissions and all -cause mortality were observed in patients with HFrEF, followed by HFmrEF and HFpEF. In all HF groups, the all -cause mortality rate was higher than the rates of urgent HF readmission.

Introduction Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. Methods Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. Results The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO ( p < .001), while lactate clearance was similar ( p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO ( p = .007) and VA ECMO ( p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. Conclusion This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Background: Current guidelines recommend coronary catheterization in patients with non -ST--segmentelevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet. Aims:The study aimed to evaluate the association between door-to-PCI time and all-cause mortality at 12 and 36 months in NSTEMI patients presenting directly to a PCI-capable center who underwent PCI within the first 24 hours of hospitalization. Methods: We analyzed data of patients hospitalized for NSTEMI between 2007-2019, included in the nationwide registry of acute coronary syndromes. Patients were stratified into twelve groups based on 2-hour intervals of door-to-PCI time. The mortality rates of patients within those groups were adjusted for 33 confounding variables by the propensity score weighting method using overlap weights. Results: A total of 37 589 patients were included in the study. The median age of included patients was 66.7 (interquartile range [IQR], 59.0-75.8) years; 66.7% were male, and the median GRACE (Global Registry of Acute Coronary Events) score was 115 (98-133). There were increased 12-month and 36-month mortality rates in consecutive groups of patients stratified by 2-hour door-to-PCI time intervals. After adjustment for patient characteristics, there was a significant positive correlation between the time to PCI and the mortality rates (rs= 0.61; P = 0.04 and rs= 0.65; P = 0.02 for 12-month and 36-month mortality, respectively). Conclusions: The longer the door-to-PCI time, the higher were 12-month and 36-month all-cause mortality rates in NSTEMI patients.

With rising numbers of cardiac implantable electronic devices (CIEDs) implanted each year, the population of patients with those devices is growing extensively [1].Large numbers of those patients will eventually require secondary procedures, including device replacements, or upgrades.As during past years , the implanted systems become surrounded by adhesive tissue and fibers, the secondary procedures have been historically associated with a higher risk of short-and long-term complications, most often including lead damage.Moreover, due to comorbidities, a high percentage of patients with CIEDs are treated nowadays with anticoagulants, which increases the risk of bleeding and pocket hematoma.Thus, electrocautery is used to mitigate the risk of periprocedural bleeding.However, the use of conventional electrocautery can risk lead dysfunction due to its thermal injury.The low-temperature electrocautery has been proven to improve local outcomes [2].Few reports were published to date on its utilization in CIED-related procedures [3][4][5].The aim of this analysis was to summarize its safety and efficacy in higher complication-risk procedures performed in a tertiary Polish center.