BACKGROUND: In patients with active infective endocarditis (IE), the relationship between timing of surgery and survival is uncertain. The objective was to evaluate clinical characteristics associated with timing of surgery and the association between surgical timing and 6-month survival in complicated, left-sided IE. METHODS: In a prospective, multicenter, observational registry (The International Collaboration on Endocarditis-PLUS, registry from 2008 to 2012), clinical factors associated with timing of surgery during the index hospitalization were determined among 485 adult patients with definite, complicated, left-sided IE who underwent cardiac surgery during their index hospitalization. The relationship between early surgical intervention (<7 days from admission to surgery center) and outcome after surgery was analyzed. The primary end point of the study was 6-month survival. RESULTS: The median time to surgery from admission to surgical center was 7 (interquartile range 2-15) days. Patients who underwent earlier surgery were more likely transferred to the surgical center (74.2% vs 46.4%, P < .001) and had a lower percentage of preexisting heart failure (before IE diagnosis) (6.0% vs 17.3%, P < .001) but higher rate of acute heart failure (53.2% vs 38.4%, P = .001). Variables independently associated with surgery <7 days from admission were patient transfer, acute heart failure, and nonelective surgical status (C-index = 0.84), but predicted operative risk was not. Cox proportional hazards modeling with inverse probability of treatment weighting found that earlier surgery was associated with a trend toward higher 6-month mortality compared with later surgery (hazard ratio = 1.68, 95% CI 0.97-2.96; P = .065), particularly surgery within 2 days of admission or transfer. Mortality was significantly associated with operative risk and complicated IE, including Staphylococcus aureus infection and presence of abscess. CONCLUSIONS: Earlier surgery in IE is strongly associated with acute heart failure and surgical urgency. After adjustment for operative risk and IE complications, earlier surgery <7 days from admission was associated with a trend toward higher 6-month overall mortality compared with surgery later in the index hospitalization.

• MeSH
• absces mortalita   MeSH
• akutní nemoc MeSH
• bakteriální endokarditida mortalita   patologie   chirurgie   MeSH
• čas zasáhnout při rozvinutí nemoci * MeSH
• chirurgie operační MeSH
• dospělí MeSH
• hospitalizace MeSH
• lidé středního věku MeSH
• lidé MeSH
• přemístění pacientů statistika a číselné údaje   MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční selhání epidemiologie   etiologie   MeSH
• stafylokokové infekce mortalita   MeSH
• Staphylococcus aureus MeSH
• tendenční skóre MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

AIMS: Subjective symptoms represent significant criteria of a patient's health condition; therefore, we focused on the long-term prevalence of heart failure symptoms and angina pectoris after myocardial infarction between two groups of patients in which two different therapeutic strategies were used during the acute phase of ST-elevation myocardial infarction (STEMI). METHODS: The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention (PCI) centre (n=429) vs. fibrinolysis in community hospitals (n=421). The data were collected from either primary hospitals or PCI centres, as well as via questionnaires. RESULTS: The mean follow-up was 58 months. At 5 years, 45.4% of patients were in New York Heart Association class I following primary PCI vs. 31.8% of those treated with fibrinolysis (OR 2.02, 95% CI 1.37-2.97, p<0.002). At 5 years, 83.6% of patients had no symptoms of angina pectoris following invasive therapy vs. 58% of patients treated with fibrinolysis (OR 4.47, 95% CI 2.79-7.18, p<0.001). CONCLUSIONS: The symptoms of angina pectoris and heart failure were significantly lower in patients assigned to primary PCI in the acute stage of myocardial infarction compared with patients treated with fibrinolysis at the 5-year follow up.

• Klíčová slova
• Angina pectoris, fibrinolysis, heart failure, long-term outcome, myocardial infarction, primary coronary intervention,
• MeSH
• infarkt myokardu patofyziologie   terapie   MeSH
• komunitní nemocnice statistika a číselné údaje   MeSH
• koronární angioplastika statistika a číselné údaje   MeSH
• koronární jednotky statistika a číselné údaje   MeSH
• lidé MeSH
• následné studie MeSH
• přemístění pacientů statistika a číselné údaje   MeSH
• senioři MeSH
• transport pacientů statistika a číselné údaje   MeSH
• trombolytická terapie statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

OBJECTIVE: Comparison of the long-term outcomes of three reperfusion strategies in patients with acute ST elevation myocardial infarction presenting to community hospitals. METHODS: One-year clinical outcomes were compared for 300 patients randomized in the PRimary Angioplasty in patients transferred from General community hospitals to specialized percutaneous coronary intervention Units with or without Emergency thrombolysis (PRAGUE-1) study to one of three treatment strategies: thrombolysis in a community hospital (group A, n=99); thrombolysis during immediate transportation for coronary angioplasty (group B, n=100); and immediate transportation for coronary angioplasty without thrombolysis (group C, n=101). RESULTS: Total mortality rates in group A, B and C patients were 18%, 12% and 13%, respectively (not significant). Nonfatal reinfarction occurred in 12%, 6% and 3% of patients, respectively (P<0.05). The combined endpoint (total mortality and nonfatal reinfarction rate) was reported in 30%, 18% and 16% of patients, respectively (P<0.05). In patients randomized within 2 h of the onset of symptoms, mortality rates were 18%, 3% and 8%, respectively (P<0.05). Additional revascularization procedures (percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery) were performed in 35%, 14% and 15% of patients, respectively (P<0.001). CONCLUSIONS: Primary angioplasty (even if delayed due to patient transportation to an interventional centre) is associated with better short- and long-term clinical outcomes than thrombolysis. The combination of the two strategies did not prove superior to coronary angioplasty alone. However, it may be superior in a subset of patients with early admission. The coronary angioplasty strategy decreases the need for revascularization procedures during the subsequent one-year follow-up.

• MeSH
• balónková koronární angioplastika statistika a číselné údaje   MeSH
• hodnocení výsledků zdravotní péče * MeSH
• infarkt myokardu mortalita   terapie   MeSH
• komunitní nemocnice statistika a číselné údaje   MeSH
• koronární jednotky statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• multivariační analýza MeSH
• následné studie MeSH
• přemístění pacientů statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• trombolytická terapie statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The author analyzes a group of casualties referred in 1997 to the Casualty Hospital Brno from other institutions where the patients were hospitalized after the injury, if the period did not exceed 30 days. Thus 361 casualties were referred. The reasons are summarized. Problematic is according to the author the admission of 37 patients with multiple injuries and 30 patients with a single injury. During the contemplated reduction of the number of health departments incl. surgical ones in the Czech Republic it will be difficult to justify the further existence of departments which are unable to cope permanently with uncomplicated bone fractures.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• přemístění pacientů statistika a číselné údaje   MeSH
• rány a poranění terapie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• traumatologická centra statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH