In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level > 60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P =0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mm Hg; P =0.034) and diastolic (75.1 versus 72.0 mm Hg; P =0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P =0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (−1.49 versus −0.35 m/s; P =0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects.

Background: The impact of acute total occlusion (TO) of the culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate the clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMI_TO) compared to NSTEMI patients without TO (NSTEMI_NTO) and those with ST-segment elevation and TO (STEMI_TO). Methods: Demographic, clinical and procedure-related data of patients with acute myocardial infarction who underwent percutaneous coronary intervention (PCI) between 2014 and 2017 from the Polish National Registry were analysed. Results: We evaluated 131,729 patients: NSTEMI_NTO (n = 65,206), NSTEMI_TO (n = 16,209) and STEMI_TO (n = 50,314). The NSTEMI_TO group had intermediate results compared to the NSTEMI_NTO and STEMI_TO groups regarding mean age (68.78 ± 11.39 vs 65.98 ± 11.61 vs 64.86 ± 12.04 (years), p < 0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03 (%), p < 0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02 (%), p < 0.0001) and death during PCI (0.43 vs 0.97 vs 1.76 (%), p < 0.0001)—for NSTEMI_NTO, NSTEMI_TO and STEMI_TO, respectively. However, we noticed that the NSTEMI_TO group had the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p < 0.0001) and the lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57 (%), p < 0.0001) and that the left circumflex artery (LCx) was most often the culprit lesion (14.09 vs 35.86 vs 25.42 (%), p < 0.0001). Conclusions: The NSTEMI_TO group clearly differed from the NSTEMI_NTO group. NSTEMI_TO appears to be an intermediate condition between NSTEMI_NTO and STEMI_TO, although NSTEMI_TO patients have the longest time delay to and the worst result of PCI, which can be explained by the location of the culprit lesion in the LCx.

Acute hyperglycaemia in patients with acute coronary syndromes (ACS) is associated with increased cardiovascular (CV) risk among both diabetic and non-diabetic patients although the mechanisms underlying this association are not clearly understood. Acute hyperglycaemia in patients with ACS may be associated with increased systemic inflammation. Leukocytes are the major cellular mediators of inflammation and their elevated count is associated with higher CV event rate in ACS patients. Thus, it is possible that there is a relationship between acute hyperglycaemia and high leukocyte count and concomitant presence of these two conditions may contribute to increased CV risk among patients with ST segment elevation myocardial infarction (STEMI). To investigate the relationship between acute hyperglycaemia and high leukocyte count and to evaluate its association with outcomes in patients with STEMI. Glucose level and leukocyte count on admission were measured in 246 patients with STEMI admitted in 2004- -2007 to the First Department of Cardiology and Hypertension at the University Hospital in Cracow who were treated with an early invasive management strategy. Patients were divided into two groups, with acute hyperglycaemia (glycaemia on admission ≥ 7.8 mmol/L) and with normoglycaemia (glycaemia on admission < 7.8 mmol/L). Leukocyte count was defined as high when it was greater than or equal to the median in the overall study group. Acute hyperglycaemia was noted in 136 (55.3%) patients. Median leukocyte count on admission in the overall study group was 10.8 × 103/mm3 (interquartile range: 8.5-13.0). Significantly higher in-hospital mortality (11.8% vs. 1.8%, p = 0.0029) and higher rates of cardiogenic shock (10.3% vs. 0.9%, p = 0.0022), Killip class > 1 heart failure (HF; 44.1% vs. 20.0%, p < 0.0001), atrial fibrillation (11.0% vs. 3.6%, p = 0.0308), ventricular fibrillation (5.9% vs. 0.9%, p = 0.0389), repeated percutaneous coronary angioplasty (5.2% vs. 0.0%, p = 0.0158), the primary endpoint defined as death and/or cardiogenic shock (16.9% vs. 1.8%, p = 0.0001), and the secondary endpoint defined as atrial fibrillation and/or second or third degree atrioventricular block and/or HF and/or stroke/transient ischaemic attack (53.7% vs. 23.6%, p < 0.0001) were noted in the acute hyperglycaemia group in comparison with the normoglycaemic group. Adverse events were associated with high leukocyte count in all patients and in both diabetic and non-diabetic subgroups. Mean leukocyte count was higher in patients who died (13.3 ± 4.01 vs. 11.0 ± 3.56 [103/mm3], p = 0.0115; 14.2 ± 1.59 vs. 10.8 ± 3.18 [103/mm3], p = 0.0210; and 13.5 ± 4.79 vs. 11.1 ± 3.72 [103/mm3], p = 0.0363 in the overall study group, diabetics and non-- diabetics, respectively), in patients with cardiogenic shock (14.0 ± 4.56 vs. 11.0 ± 3.52 [103/mm3], p = 0.0019; and 15.4 ± 4.93 vs. 11.0 ± 3.66 [103/mm3], p = 0.0007 in the overall study group and non-diabetics, respectively), and in patients with HF (12.1 ± 3.78 vs. 10.8 ± 3.51 [103/mm3], p = 0.0083; and 12.1 ± 3.39 vs. 10.3 ± 2.90 [103/mm3], p = 0.0159 in the overall study group and diabetics, respectively) as compared to patients without respective adverse events. Glucose level on admission correlated positively with the on-admission leukocyte count. This correlation was statistically significant in the overall study group (r = 0.25, p < 0.0001), in diabetics (r = 0.27, p = 0.021), and in non-diabetics (r = 0.35, p < 0.0001). Patients with both acute hyperglycaemia and the leukocyte count greater than or equal to the median in the overall study group had a higher in-hospital risk of death and/or cardiogenic shock (odds ratio 17.6, 95% CI 1.9-165.3, p = 0.0122). Acute hyperglycaemia is associated with worse in-hospital outcomes in patients with STEMI. More severe inflammation (defined as leukocyte count on admission) is noted in STEMI patients with adverse events. A significant positive correlation can be seen between glucose level and leukocyte count on admission, and concomitant presence of both acute hyperglycaemia and more severe inflammation in patients with STEMI was found to be an independent predictor of poor in-hospital outcomes.

Background: Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19. Methods: We studied all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to COVID-19 between March 2020 and May 2021. Data of 5191 patients (mean age 61.9±16.7 years, 45.2% female) were analyzed. Results: The median hospitalization time was 14 days, and the mortality rate was 18.4%. About a quarter of patients had an established cardiovascular disease including coronary artery disease (16.6%) or stroke (7.6%). Patients with hypertension (58.3%) were older and had more comorbidities than patients without hypertension. In multivariable logistic regression analysis, age above median (64 years), male gender, history of heart failure or chronic kidney disease, and higher C-reactive protein level, but not preexisting hypertension, were independent risk factors for in-hospital death in the whole study group. Patients with hypertension already treated (n=1723) with any first-line antihypertensive drug (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, or thiazide/thiazide-like diuretics) had a significantly lower risk of in-hospital death (odds ratio, 0.25 [95% CI, 0.2–0.3]; P<0.001) compared to nontreated hypertensives (n=1305). Conclusions: Although the diagnosis of preexisting hypertension per se had no significant impact on in-hospital mortality among patients with COVID-19, treatment with any first-line blood pressure–lowering drug had a profound beneficial effect on survival in patients with hypertension. These data support the need for antihypertensive pharmacological treatment during the COVID-19 pandemic. Download figure Download PowerPoint

Background. Diabetes is a risk factor for a severe course of COVID-19. We evaluated the characteristics and risk factors associated with undesirable outcomes in diabetic patients (DPs) hospitalized due to COVID-19. Materials and Methods. The data analysis of patients admitted between March 6, 2020, and May 31, 2021, to the University Hospital in Krakow (Poland), a reference center for COVID-19, was performed. The data were gathered from their medical records. Results. A total number of 5191 patients were included, of which 2348 (45.2%) were women. The patients were at the median age of 64 (IQR: 51–74) years, and 1364 (26.3%) were DPs. DPs, compared to nondiabetics, were older (median age: 70 years, IQR: 62–77 vs. 62, IQR: 47–72, and < 0.001) and had a similar gender distribution. The DP group had a higher mortality rate (26.2% vs. 15.7%, < 0.001) and longer hospital stays (median: 15 days, IQR: 10–24 vs. 13, IQR: 9–20, and < 0.001). DPs were admitted to the ICU more frequently (15.7% vs. 11.0%, < 0.001) and required mechanical ventilation more often (15.5% vs. 11.3%, < 0.001). In a multivariate logistic regression, factors associated with a higher risk of death were age >65 years, glycaemia >10 mmol/L, CRP and D-dimer level, prehospital insulin and loop diuretic use, presence of heart failure, and chronic kidney disease. Factors contributing to lower mortality were in-hospital use of statin, thiazide diuretic, and calcium channel blocker. Conclusion. In this large COVID-19 cohort, DPs constituted more than a quarter of hospitalized patients. The risk of death and other outcomes compared to nondiabetics was higher in this group. We identified a number of clinical, laboratory, and therapeutic variables associated with the risk of hospital death in DPs.