Introduction: Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim: The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods: The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009-2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m 2 , hemodialysis. Mean observation time was 2296 days. Results: Criteria were met by 2213 patients. CKD occurred in 24.1% (N ¼ 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p ¼ .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567-5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029-4.463, p ¼ .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056-4.959, p ¼ .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481-3.424, p < .001). Conclusion: PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.

Introduction Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12–1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17–1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97–0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.

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IntroductionAcute coronary syndromes (ACS) are the leading cause of death all over the world. In the last years, the chronobiology of their occurrence has been changing.Material and methodsMedical records of 10,529 patients hospitalized for ACS in the Medical University of Bialystok, in 2008–2017, were examined. Weather conditions data for Bialystok County were obtained from the Institute of Meteorology.Results: The highest seasonal mean for ACS was recorded in spring (OR = 1.08, 95% CI: 1.00–1.18, p = 0.049) and it was the season with the largest temperature changes from day to day (∆ temp. = 11.01). On the other hand, every 10ºC change in temperature was associated with increased admission due to ACS by 13% (RR = 1.13, 95% CI: 1.040–1.300, p = 0.008) and 12% in patients over 70 (RR = 1.118, 95% CI: 1.001–1.249, p = 0.048, lag 1). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (OR = 1.16, 95% CI: 1.05–1.28, p = 0.003), while in the STEMI subgroup it was Monday (n = 592, mean = 0.94, SD = 1.04, OR = 1.20, 95% CI: 1.07–1.36, p = 0.003). Sunday was associated with decreased admissions due to all types of ACS (OR = 0.70, 95% CI: 0.63–0.77, p < 0.001).ConclusionsWeather conditions have an impact on ACS frequency and the elderly are more susceptible. We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuations associated with climate change in this season. The lowest frequency of ACS took place on weekends.

Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing. Purpose The aim of this study was to assess the influence of climate change on hospital admissions due to ACS. Methods Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology. Results Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P &lt; 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower. Conclusion We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.