Kardiol Pol
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Management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) depends on risk evaluation. The recommended approach involves the use of risk stratification tools such as TIMI and GRACE risk scores. However, these clinical scores do not include variables derived from coronary angiography which is currently performed in most patients. ⋯ The extent score added to the TIMI risk score improves the prognostic value of the latter in patients with NSTEMI. Angiographic variables should be more widely used in risk stratification models in patients with acute coronary syndromes.
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Platelets play a key role in the development and progression of cardiovascular disease. The degree of platelet activation may be assessed by platelet indices such as platelet count, mean platelet volume (MPV) and platelet distribution width (PDW). ⋯ PDW and MPV may not be related to the clinical features or presentation and extent of CAD. Our study findings add to the conflicting results of previous studies in this area. Prospective trials with longer follow-up periods and larger samples are warranted to conclusively define the role of platelet indices in CAD.
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Retrospective evaluation of stroke risk in all patients with atrial fibrillation (AF) admitted to cardiology, internal medicine, and neurology wards in a single Polish district hospital in 2006 and 2010 using two risk stratification schemes, CHADS₂ vs. CHA₂DS₂VASc risk scores and identification of independent predictors of guideline-compliant oral anticoagulant (OAC) treatment. ⋯ Despite a high stroke risk as determined by both scores, only 39% of patients received OAC. In the studied population, independent predictors for prescribing OAC at discharge included arterial hypertension (in accordance with the guidelines) and younger patient age, no history of stroke/TIA, and AF other than paroxysmal. The practice of OAC and/or antiplatelet therapy use in AF patients discharged from a Polish district hospital was not compliant with the current ESC guidelines either in 2006 or in 2010.
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Incompleted ST segment resolution (STR) after primary percutaneous coronary intervention (PCI) is associated with worse clinical outcomes. ⋯ Plasma NT-proBNP level on admission is a strong and independent predictor of no-reflow phenomenon following primary PCI and mid-term cardiovascular mortality in patients with STEMI.