BACKGROUND AND AIMS: Myocardial infarction (MI) in multivessel disease (MVD) and chronic total occlusion (CTO) is associated with high mortality. However, all-cause mortality of matched cohort without a CTO is unclear. Our aim was to analyse clinical characteristics, presenting symptoms, and survival of patients with MI in MVD and the possible impact of CTO on 1-year mortality. METHODS: All MI patients with MVD (two or three vessel disease) hospitalized in our center from January 2020 to September 2022 (1309 patients) were selected. We conducted a propensity score matching (PSM) analysis based on age, gender, type of MI, and compared patients with CTO (CTO group, n = 90) and without CTO (Control group, n = 90). RESULTS: We observed no difference in presenting clinical symptoms and initial heart rhythm between the groups. 1-year follow-up shows all-cause mortality rate of 23.3 % (n = 21) in the CTO group (Mean survival [MS] = 292.1 days, 95 % CI = 263.8 to 320.4) and 18.9 % (n = 17) in the Control group (MS = 310.2 days, 95 % CI = 285.3 to 335.2), p = 0.44. PCI alone was performed in 64.4 % (n = 58) in both groups, CABG in 18.8 % (n = 17) and 24.4 % (n = 22) (CTO vs. Control group respectively). Combination of PCI and CABG occurred in 8.8 % (n = 8) in both groups. Conservative treatment was chosen for 7 CTO and 2 Control group patients. CONCLUSION: We observed no 1-year mortality difference in patients with MI, MVD and a CTO compared to a matched cohort of patients with MI, MVD without CTO. Excellent 1-year survival was observed in patients treated by CABG, irrespective of CTO presence.
- MeSH
- chronická nemoc MeSH
- infarkt myokardu * mortalita diagnóza MeSH
- kohortové studie MeSH
- koronární angioplastika metody MeSH
- koronární okluze * diagnóza mortalita chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití trendy MeSH
- následné studie MeSH
- nemoci koronárních tepen mortalita diagnóza chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tendenční skóre MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Akutní plicní embolie (PE) je časté a život ohrožující onemocnění, jehož mortalita je stále nepřiměřeně vysoká. Katetrizační léčba plicní embolie patří mezi rychle se rozvíjející oblasti intervenční medicíny a již nyní je na některých specializovaných pracovištích dostupná. Cílem přehledového článku je stručné představení intervenční léčby akutní PE širší odborné veřejnosti, informování o jejím současném postavení ve světle platných Doporučených postupů a v neposlední řadě také nastínění budoucího možného rozvoje této oblasti.
Acute pulmonary embolism (PE) is a common and life-threatening condition with inappropriately high mortality rates. Catheter-directed treatment (CDT) for acute PE is a rapidly evolving field of interventional medicine and is already available in some specialized centers. The aim of this review article is to briefly introduce CDT for acute PE to a wider professional community, to provide information on its status in the light of current guidelines, and, last but not least, to outline possible further development in this field.
- MeSH
- katetrizace metody MeSH
- lidé MeSH
- plicní embolie * terapie MeSH
- trombektomie metody MeSH
- trombolytická terapie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
There are several differences between younger and older adults with acute coronary syndrome (ACS). However, few studies have evaluated these differences. We analysed the pre-hospital time interval [symptom onset to first medical contact (FMC)], clinical characteristics, angiographic findings, and in-hospital mortality in patients aged ≤50 (group A) and 51-65 (group B) years hospitalised for ACS. We retrospectively collected data from 2010 consecutive patients hospitalised with ACS between 1 October 2018 and 31 October 2021 from a single-centre ACS registry. Groups A and B included 182 and 498 patients, respectively. ST-segment elevation myocardial infarction (STEMI) was more common in group A than group B (62.6 and 45.6%, respectively; P < 0.001). The median time from symptom onset to FMC in STEMI patients did not significantly differ between groups A and B [74 (40-198) and 96 (40-249) min, respectively; P = 0.369]. There was no difference in the rate of sub-acute STEMI (symptom onset to FMC > 24 h) between groups A and B (10.4% and 9.0%, respectively; P = 0.579). Among patients with non-ST elevation acute coronary syndrome (NSTE-ACS), 41.8 and 50.2% of those in groups A and B, respectively, presented to the hospital within 24 h of symptom onset (P = 0.219). The prevalence of previous myocardial infarction was 19.2% in group A and 19.5% in group B (P = 1.00). Hypertension, diabetes, and peripheral arterial disease were more common in group B than group A. Active smoking was more common in group A than group B (67 and 54.2%, respectively; P = 0.021). Single-vessel disease was present in 52.2 and 37.1% of participants in groups A and B, respectively (P = 0.002). Proximal left anterior descending artery was more commonly the culprit lesion in group A compared with group B, irrespective of the ACS type (STEMI, 37.7 and 24.2%, respectively; P = 0.009; NSTE-ACS, 29.4 and 21%, respectively; P = 0.140). The hospital mortality rate for STEMI patients was 1.8 and 4.4% in groups A and B, respectively (P = 0.210), while for NSTE-ACS patients it was 2.9 and 2.6% in groups A and B, respectively (P = 0.873). No significant differences in pre-hospital delay were found between young (≤50 years) and middle-aged (51-65 years) patients with ACS. Although clinical characteristics and angiographic findings differ between young and middle-aged patients with ACS, the in-hospital mortality rate did not differ between the groups and was low for both of them.
- Publikační typ
- časopisecké články MeSH
- MeSH
- aortální insuficience diagnostické zobrazování MeSH
- aortální stenóza chirurgie diagnostické zobrazování patofyziologie patologie MeSH
- diagnostické techniky kardiovaskulární MeSH
- echokardiografie MeSH
- fyzikální vyšetření MeSH
- hemodynamické monitorování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mitrální insuficience chirurgie diagnostické zobrazování patologie MeSH
- mitrální stenóza diagnóza patofyziologie MeSH
- nemoci srdečních chlopní * chirurgie diagnostické zobrazování klasifikace patologie MeSH
- srdeční chlopně umělé klasifikace MeSH
- stupeň závažnosti nemoci MeSH
- trikuspidální insuficience diagnostické zobrazování terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- cévy anatomie a histologie MeSH
- hemodynamické monitorování * metody škodlivé účinky MeSH
- kardiovaskulární fyziologické jevy * MeSH
- koronární cévy anatomie a histologie diagnostické zobrazování fyziologie MeSH
- lidé MeSH
- srdce anatomie a histologie fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality. AREAS COVERED: The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided. EXPERT OPINION: Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
BACKGROUND: Intermediate-high risk acute pulmonary embolism (PE) remains associated with substantial mortality despite anticoagulation therapy. AIMS: The aim of this randomised pilot study was to compare catheter-directed thrombolysis to standard anticoagulation therapy. METHODS: Intermediate-high risk acute PE patients were admitted to a tertiary care centre (November 2019 to April 2021) and randomised in a 1:1 ratio to catheter-directed thrombolysis (CDT) or standard anticoagulation. Two catheters were used for the infusion of alteplase (1 mg/hr/catheter; total dose 20 mg) in the CDT group. The primary efficacy endpoint targeted improvement of right ventricular (RV) function, a decrease in pulmonary pressure, and a reduction of thrombus burden. RESULTS: Twenty-three patients were included (12 in the CDT group and 11 in the standard care group). The primary efficacy endpoint was achieved more frequently in the CDT group than in the standard care group (7 of 12 patients vs 1 of 11 patients, p=0.0004). An RV/left ventricular ratio reduction ≥25% (evident on computed tomography angiography) was achieved in 7 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.03). A systolic pulmonary artery pressure decrease of ≥30% or normotension at 24 hrs after randomisation was present in 10 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.001). There was no intracranial or life-threatening bleeding (type 5 or 3c bleeding, according to the Bleeding Academic Research Consortium classification). CONCLUSIONS: CDT for intermediate-high risk acute PE appears to be safe and effective. Further research is warranted to assess clinical endpoints.
- MeSH
- akutní nemoc MeSH
- antikoagulancia terapeutické užití MeSH
- fibrinolytika terapeutické užití MeSH
- katétry MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- pilotní projekty MeSH
- plicní embolie * terapie MeSH
- tkáňový aktivátor plazminogenu * terapeutické užití MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Magnesium-based bioresorbable Magmaris stents are rapidly resorbed. Few randomized studies have evaluated the efficacy of such stents in patients with acute coronary syndrome. AIM: To investigate late lumen loss as assessed via quantitative coronary angiography (QCA) and optical coherence tomography (OCT) in patients with acute coronary syndrome treated with Magmaris stents or permanent, everolimus-eluting metallic Xience stents. METHODS AND RESULTS: This PRAGUE-22 study was a two-centre, investigator-initiated, randomized study. Fifty patients were randomized based on the inclusion criteria for acute coronary syndrome and the anatomical suitability to receive Magmaris or Xience stents. The patient characteristics did not differ between the Magmaris group (n = 25) and Xience group (n = 25). The mean ages were 57.0 ± 10.5 vs. 55.5 ± 9.2 years (p = 0.541) and the total implanted stent length was 24.6 ± 10.7 mm vs. 27.6 ± 11.1 mm (p = 0.368), respectively. Four clinical events occurred in the Magmaris group and one in the Xience group during 12 months of follow-up. The extent of late lumen loss (assessed via QCA) at 12 months was greater in the Magmaris group than in the Xience group (0.54 ± 0.70 vs. 0.11 ± 0.37 mm; p = 0.029). The late lumen loss diameter (measured via OCT) in the Magmaris group was also significantly larger than that in the Xience group (0.59 ± 0.37 vs. 0.22 ± 0.20 mm; p = 0.01). CONCLUSION: Implantation of a magnesium-based bioresorbable stent in patients with acute coronary syndrome is associated with a greater extent of late lumen loss at the 12-month follow-up compared with implantation of a permanent, everolimus-eluting metallic stent. TRIAL REGISTRATION: ISRCTN89434356.
- MeSH
- akutní koronární syndrom * diagnostické zobrazování terapie MeSH
- everolimus škodlivé účinky MeSH
- hořčík MeSH
- koronární angiografie MeSH
- koronární angioplastika * škodlivé účinky metody MeSH
- lidé MeSH
- nemoci koronárních tepen * terapie MeSH
- sirolimus MeSH
- stenty uvolňující léky * MeSH
- vstřebatelné implantáty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Many scoring systems for predicting the outcomes of patients with acute coronary syndrome (ACS) have been proposed. In some populations, a significant reduction in length of hospital stay may be achieved without compromising patient prognoses. However, the use of such scoring systems in clinical practice is limited. The aim of this study was to propose a universal list of predictors that can identify low-risk ACS patients who may be eligible for an earlier hospital discharge without increased short-term risk for major adverse cardiac events. A cohort of 1420 patients diagnosed with ACS were enrolled into a single-centre registry between October 2018 and December 2020. Clinical, laboratory, echocardiographic, and angiographic measurements were taken for each patient and entered into the study database. Using retrospective univariant analyses of patients treated with percutaneous coronary intervention (PCI) (n = 932), we compared each predictor to 30-day mortality rate using the Czech national registry of dead people. Eleven predictors correlate significantly with 30-day survival: age <80 years, ejection fraction >50%, no cardiopulmonary resuscitation, no mechanical ventilation needed, Killip class I at admission, haemoglobin levels >110 g/L while hospitalized, successful PCI procedure(s), no residual stenosis over 90%, Thrombolysis in Myocardial Infarction 3 flow after PCI, no left main stem disease, and no triple-vessel coronary artery disease. In all, presence of all predictors applies to 328 patients (35.2% of the cohort), who maintained a 100% survival rate at 30 days. A combination of clinical, echocardiographic, and angiographic findings provides valuable information for predicting the outcomes of patients with all types of ACS. We created a simple, useful tool for selecting low-risk patients eligible for early discharge.
- Publikační typ
- časopisecké články MeSH
Managing patients with acute coronary syndrome (ACS) in an ageing population with comorbidities is clinically and economically challenging. Well-conducted unselected registries are essential for providing information on real-day clinical practice. The aim was to create a long term, very detail-controlled registry of unselected patients admitted with ACS to a high-volume centre in Central Europe. Consecutive patients admitted with confirmed ACS were entered into the prospective registry from 1 October 2018 to 30 September 2021. Data on 214 parameters, including clinical characteristics, angiographic findings, laboratory and therapeutic findings, financial costs, and in-hospital mortality, were obtained for all patients. Analyses were performed on the complete dataset of 1804 patients. Of these patients, 694 (38.5%) were admitted for ST-segment elevation myocardial infarction (STEMI) and 1110 (61.5%) were admitted for non-ST-elevation (NSTE)-ACS [779 with NSTE myocardial infarction (NSTE-MI) and 331 with unstable angina (UA)]. Almost all patients (99%) underwent coronary angiography. Primary percutaneous coronary intervention (PCI) was performed in 93.4% of STEMI patients and 74.5% of NSTE-ACS patients. Patients with NSTE-MI had the longest total hospital stay (8.1 ± 9.1 days) and highest financial costs (8579.5 ± 7173.2 euros). In-hospital mortality was 1.2% in UA, 6.2% in NSTE-MI, and 10.9% in STEMI patients. Age older than 75 years, pre-hospital cardiac arrest and/or mechanical ventilation, subacute STEMI, and ejection fraction below 40% were the most powerful predictors of in-hospital mortality as assessed by multivariate analyses. The in-hospital mortality of unselected NSTE-MI and STEMI patients in daily practice is not low despite very good implementation of guideline-recommended therapy with a high rate of revascularization. The highest financial costs are associated with NSTE-MI.
- Publikační typ
- časopisecké články MeSH
Cardiac computed tomography (CT) is vital for safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to determine the accuracy of fully automated CT analysis of aortic root anatomy before TAVI by Philips HeartNavigator software. This prospective, academic, single-centre study enrolled 128 consecutive patients with native aortic valve stenosis considered for TAVI. Automated HeartNavigator software was compared to the standard manual CT analysis by experienced operators using FluoroCT software. The sizing of the aortic annulus by perimeter and area significantly differed between both methods: mean perimeter was 76.43 mm vs. 77.52 mm (P < 0.0001) using manual FluoroCT vs. automated HeartNavigator software; mean area was 465 mm2 vs. 476 mm2 (P < 0.0001). Interindividual variability testing revealed mean differences between the two operators were 1.21 mm for the aortic annulus perimeter and 9 mm2 for the aortic annulus area. The hypothetical self-expandable transcatheter prosthesis sizing resulted in 80% agreement in 80% of cases. The time required to perform the automated CT analysis was significantly shorter than the time required for manual analysis (mean 17.8 min vs. 2.1 min, P < 0.0001). Philips HeartNavigator fully automated software for pre-TAVI CT analysis is a promising technology. Differences detected in aortic annulus dimensions are small and similar to the variability of manual CT analysis. Automated prediction of optimal fluoroscopic viewing angles is accurate. Correct transcatheter prosthesis sizing requires clinical oversight.
- Publikační typ
- časopisecké články MeSH
Transcatheter aortic valve implantation (TAVI) has become a high-volume procedure with increasing demands on hospital resources. Local anaesthesia with sedation supervised by an anaesthesiology team is the current standard of care. We aimed to describe our experience with a simplified, nurse-led sedation (NLS) protocol. This study enrolled 128 consecutive patients who underwent transfemoral TAVI with self-expandable Evolut R prosthesis between November 2019 and April 2021. Operators selected 50% of patients for NLS based on the clinical expectation of lower risk of procedural difficulties. Nurse-led sedation protocol demanded only mild to moderate levels of sedation. The clinical outcomes were determined from the local TAVI registry and the national mortality database. Baseline patient characteristics were similar in the NLS (n = 64) and anaesthesiologist-led sedation (ALS) (n = 64) groups except higher prevalence of diabetes mellitus (48.4% vs. 31.3%, P = 0.035) and peripheral vascular disease (20.3% vs. 7.8%, P = 0.036) in the ALS group. There was a trend for the larger prostheses used in the ALS group (P = 0.058). The procedural results did not differ, and coronary care team backup was rarely needed in the NLS group (6% of patients). The in-hospital outcomes were identical from both clinical and echocardiography perspectives, and 30-day mortality was low in both groups (1.5%). For the NLS group, preparation in the catheterization laboratory was quicker by 6.4 min (P = 0.01), and intensive care unit stay was shorter (2.03 vs. 3.48 days, P = 0.001). In conclusion, the NLS for the selected transfemoral TAVI population seems safe.
- Publikační typ
- časopisecké články MeSH
Long-term follow-up after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) beyond 5 years is poorly described. There are no risk-stratification systems available for routine use. This retrospective, academic, two-centre analysis included consecutive patients who presented with acute STEMI between March 2008 and December 2019. In total, 5263 patients underwent pPCI; all patients were included in the analysis only once. Baseline characteristics were gathered from prospective local registries and based on initial hospitalization. The study enrolled 5263 patients who had been treated with pPCI; it found that cardiovascular mortality was the most frequent cause of death (65.0%) on long-term follow-up to 12 years. Myocardial infarction associated mortality was 27.2%. Cardiovascular mortality was dominant, including in the landmark analysis beyond 1 year. Multivariate analysis identified significant predictors for long-term cardiovascular mortality: age, history of diabetes mellitus, history of renal insufficiency, history of heart failure, Killip class, and successful pPCI at presentation. A predictive model was built to evaluate the risk of cardiovascular death with a high discrimination value (C-statistic = 0.84). Cardiovascular diseases remain the leading cause of long-term mortality after pPCI in the Central European population. Our novel predictive model provides risk stratification; it could identify patients who would experience the greatest benefit from aggressive secondary prevention measures.
- Publikační typ
- časopisecké články MeSH
Katetrizační implantace aortální chlopně (TAVI) je stejně jako všechny biologické chlopenní protézy spojena s užíváním antitrombotické terapie, jejímž cílem je minimalizovat riziko tromboembolických a ischemických příhod při nízkém výskytu krvácivých komplikací. Periprocedurální i dlouhodobá léčebná antitrombotická strategie byla v počátcích této metody převzata od terapie po perkutánních koronárních intervencích bez jakékoli dostupné evidence. Současná doporučení antitrombotické terapie u pacientů postupujících TAVI jsou založena na zkušenostech a konsensu expertů, přičemž používání antitrombotické terapie v klinické praxi se často dle různých pracovišť liší. Cílem tohoto článku je poskytnout přehled současných poznatků týkajících se optimální antitrombotické strategie pacienta po TAVI. První data z randomizovaných studií směřují spíše k méně intenzivní monoterapii; v případě pacientů bez indikace k antikoagulaci k monoterapii aspirinem a v případě pacientů s indikovanou antikoagulační terapií pouze k antikoagulaci samotné. Je však třeba vyčkat na potvrzení těchto dat v dalších studiích a také v delším časovém horizontu.
Transcatheter aortic valve implantation (TAVI), as is the case with all bioprosthetic valves, requires the use of antithrombotic therapy to minimise thromboembolic and ischaemic events while keeping the incidence of bleeding complications low. Periprocedural and long-term antithrombotic strategy after TAVI was, from the beginning, empirically based on the treatment administered after percutaneous coronary interventions. Current guidelines for antithrombotic therapy after TAVI are based on experience and consensus of experts; however, there are significant practice variations among different hospitals and countries. This article aims to provide an overview of the current knowledge on an optimal post-TAVI antithrombotic strategy. The first randomised data point in the direction of less aggressive monotherapy; aspirin monotherapy in patients without indication for anticoagulation; and anticoagulation alone in those with an already established indication for anticoagulation therapy before TAVI. However, these results must be confirmed in further studies as well as in longer-term follow-up.
This review summarizes the information available from long-term follow-up after ST-elevation myocardial infarction (STEMI) in the primary percutaneous coronary intervention (p-PCI) era. The main aim of this review is to present an overview of long-term overall mortality, cardiac mortality, and major adverse cardiac events (MACE). We searched and analyzed trials with 5-year and longer follow-up periods published from January 2001 to December 2019. Only p-PCI trials were included. Overall mortality at 5-year follow-up was 9.3-23.3 % and annual overall mortality was around 2 % for the years following the first one after STEMI. Cardiac mortality at 5-year follow-up was 4.7-16.0 % and annual cardiac mortality was approximately 1.1-1.5 % for the years following the first one after STEMI. The cumulative incidences of reinfarction at 5-year follow-up, heart failure requiring admission, additional revascularization, and stroke were 5.0-18.0, 4.0-18.5 %, 19.0-37.1 %, and 2.6-8.0 %, respectively. The cumulative incidence of in-stent thrombosis was 2.6 %. The cumulative incidence of restenosis was 7.8 %. The results of the above-mentioned trials suggest a high proportion of cardiovascular deaths and MACE in the long-term follow-up period. With respect to these facts, questions arise as to how to reduce MACE and the possibility of routine use of coronary artery imaging in the follow-up.
Tento přehledový článek shrnuje informace dostupné z dlouhodobého sledování pacientů po infarktu myokardu s elevacemi ST úseku (STEMI) v éře primární perkutánní koronární intervence (p-PCI). Jeho hlavním cílem je poskytnout přehled o dlouhodobé celkové mortalitě, kardiální mortalitě a závažných nežádoucích kardiovaskulárních příhodách (MACE). Vyhledali jsme a analyzovali studie s pětiletým a delším obdobím sledování publikované od ledna 2001 do prosince 2019. Do přehledu jsme zařadili pouze studie týkající se p-PCI. Celková mortalita v pěti letech sledování byla 9,3-23,3 % a roční celková mortalita se v letech, které následovaly po uplynutí prvního roku po STEMI, pohybovala okolo 2 %. Kardiální mortalita v pěti letech sledování byla 4,7-16,0 % a roční kardiální mortalita v letech, které následovaly po uplynutí prvního roku po STEMI, byla přibližně 1,1-1,5 %. Kumulativní incidence reinfarktu v pěti letech sledování byla 5,0-18,0 %, srdečního selhání vyžadujícího hospitalizaci 4,0-18,5 %, další revaskularizace 19,0-37,1 % a cévní mozkové příhody 2,6-8,0 %. Kumulativní incidence trombózy ve stentu byla 2,6 %. Kumulativní incidence restenózy byla 7,8 %. Výsledky výše zmíněných studií svědčí o vysokém procentu kardiovaskulárních úmrtí a MACE během dlouhodobého sledování. Vzhledem k těmto skutečnostem vyvstávají otázky ohledně způsobu snížení výskytu MACE a možnosti rutinního využití zobrazování koronárních tepen v období sledování.
