Kardiol Pol
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Proper selection of patients at high risk for sudden cardiac death (SCD) and increasing use of implantable cardioverter-defibrillators (ICD) may contribute to improved survival among patients at the highest SCD risk. ⋯ Death rate was higher in patients with LVEF <30%, NYHA class III or IV, no DFT performed and no statin treatment. In these patients, indications for cardiac resynchronisation therapy should be considered. HR <78 bpm and QRS width <118 ms are independent protective factors. HR >78 bpm was observed in all SCD patients. Sicker ICD patients live for a shorter time. The presence of atrial fibrillation, number of antiarrhythmic ICD interventions, ICD type and revascularisation approach did not affect survival/mortality.
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Despite significant progress on the diagnosis work-up of patients with suspented acute pulmonary embolism (APE), several therapeutic and prognostic issues have not yet been well established. ⋯ Despite adequate treatment there is a possibility of haemodynamic collapse and the need for thrombolysis in approximately 9% of intermediate risk APE patients. Not only age and compromised haemodynamic status but also plasma creatinine, NT-proBNP, and troponin I levels are prognostic factors of early in-hospital mortality in patients with APE. Due to high mortality rate among non-thrombolysed high risk patients, their therapy should be more aggressive and contraindications for thrombolysis should be less restrictive.
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Randomized Controlled Trial
Polyunsaturated omega-3 fatty acids improve responsiveness to clopidogrel after percutaneous coronary intervention in patients with cytochrome P450 2C19 loss-of-function polymorphism.
Antiplatelet properties of omega-3 polyunsaturated fatty acids (PUFA) have been demonstrated in patients with coronary artery disease (CAD). It is unknown whether omega-3 PUFA can enhance platelet inhibition on standard aspirin and clopidogrel treatment in the setting of CYP2C19 loss-of-function polymorphism. ⋯ The addition of omega-3 ethyl esters significantly potentiates platelet response to clopidogrel after PCI mostly in patients with CYP2C19 loss-of-function polymorphism.
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Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM). ⋯ Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.