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Background Every year more than 100,000 acute coronary syndromes are diagnosed in Poland. There are 36 cardio-surgical centers and more than 157 catheterization laboratories available in Poland dedicated to treat acute coronary syndromes. MVD patients have a considerable clinically relevant burden of adverse cardiovascular events following ACS. Purpose The aim of the study was to analyze the outcomes of acute coronary syndrome (ACS) treatment in Polish patients with the multivessel coronary disease (MVD) in the centers with and without cardiac surgery (CS) on site. Methods This was a retrospective analysis (1st January, 2017 to 31st December, 2020) of ACS patients outcomes using data from PL-ACS registry. PL-ACS registry is a polish archive of the ACS patients, which data are obtained from all cardiology and cardiac surgery departments in Poland. The registry is supervised by the Polish Ministry of Health. The following analysis considered only patients with MVD. MVD was defined as the presence of ≥70% diameter stenosis of three or more epicardial coronary arteries. For the purpose of this analysis the MVD patients (n=4618) were divided to two groups: those treated in the centers with the cardiac surgery department on site (CS group, n=595) and those without (non-CS group, n=4023). Results Patients in the CS group were elder (70.8 vs. 69.0, p=0.008) as compared to the non-CS group. There were no differences in sex (male 68.6% vs. 67.2%, p=0.49) and BMI (27.5% vs. 27.7%, p=0.12) were between both groups. There was no statistically significant difference between the types of acute coronary syndrome, between CS and non-CS group – [STEMI (34.6% vs 31.1%), NSTEMI (53.6% vs 55.3%), UA (11.8% vs 13.6%), p=0.16]. Patients in the CS group had higher prevalence of renal failure (13.3% vs. 8.8%, p≤0.001) and a more frequent had a history of a past coronary angioplasty (18.9% vs. 14.4%, p=0.005). During the coronary angiography a femoral artery access was more often used in CS group patients (47.1% vs. 15.2%, p<0.001). Percutaneous coronary intervention of MVD was more often performed in the CS group (74.6% vs. 71.0%, p=0.054). In-hospital death (7.6% vs. 4.6%, p=0.002), reinfarction (1.1% vs. 0.1%, p<0.001), hemorrhagic complications (6.4% vs. 1.6%, p<0.001), recurrent target vessel revascularization (1.8% vs. 0.4%, p≤0.001) and pulmonary oedema (3.7% vs. 1.5%, p<0.001) occurred more often in the CS group. Conclusions The safety of ACS treatment in MVD patients in centers without CS on site is non-inferior to treatment of such patients in center with CS on site. Interestingly, there were more in-hospital adverse cardiac events observed in ACS MVD patients treated in center with CS on-site. However, in centers with CS on site ACS MVD patients had a higher co-morbidity and were subjected to a higher number of PCIs. It suggests that in general, centers with CS-onsite treat more severe patients as compared to those without CS on-site. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Cardiology statutory grant Background The presence of atrial fibrillation (AF) in cardiac resynchronization therapy (CRT) recipients is common and AF is a marker of poorer CRT response. The negative influence of AF on CRT efficacy is belived to be mediated mainly by the drop of effectively captured biventricular paced beats percentage (BiVp%). According to observational trials, the minimal BiVp associated with better outcomes is 95-98%, however there is lack of randomized trials to confirm this findings. Purpose The purpose of the study was to assess the influence of BiVp% itself on the clinical outcomes in the population CRT patients with atrial fibrillation in a prospective, randomized cohort. Methods The study included the prospective Pilot-CRAfT study participants that is patients with CRT and permanent or persistent AF lasting for ≥6 months that were randomly assigned to rhythm or rate control strategy. We divided the whole study population according to their BiVp at the 12 month follow-up with two borderline BiVp values (BiVp >98% vs <98% and >95% vs <95%) and analysed the echocardiographic indices, exercise tolerance and quality of life between the prespecified groups. Results The study included 43 CRT patients (97,7% males) aged 68,4 (SD: ±8,3) years with mean BiVp% 82,4% ±9,7% at baseline. The mean baseline left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and maximal oxygen uptake (VO2max) were: 30 ±8%, 65 ±8 mm, 14 ±5 mL/(kg*min), respectively. In both of the study arms the BiVp% raised significantly reaching 98,1 ±2,3% and 96,3 ±3,9% in the rhythm control and the rate control arms respectively (P=0,093). As a result the were overall 21 patients with BiVp >98% and 29 patients with BiVp >95% at the end of the study. The BiVp groups >98% vs <98% and >95% vs <95% did not differ as to baseline characteristics and we have not observed any differences in the mean LVEF, mean LVEDD, mean VO2max, and quality of life in the prespecified BiVp% groups at the end of the follow up. Moreover no linear correlations between the BiVp% and LVEF, LVEDD, VO2max values were observed. However, in the rate control group patients with AVNA performed had lower LVEDD at the end of the study (57,7 ±3,0 vs 65,4 ±7,0 p=0,007) and significant decrease in the LVEDD after AVNA was observed (-8,6 95%CI [-14,9; -2,3]). Conclusions The BiVp >98% or >95% alone does not seem to warrant good response to cardiac resynchronization in patients with persistent atrial fibrillation as assessed in the prospective randomized cohort. However, performing AVNA in this group of patients may be beneficial in terms of LVEDD decrease.

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