Browsing by Author "Savić, Lidija (16507811000)"

Introduction: Differences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. Current knowledge on differences in left ventricular myocardial function and infarct size is limited. The aim of this study was to assess baseline clinical characteristics, imaging findings, and therapeutic approach and to compare differences in echocardiographic findings at baseline and 3-month follow-up in patients with SCAD-STEMI and type 1 STEMI. Methods: This was a prospective multicenter study of 32 female patients (18–55 years of age) presenting with either SCAD-STEMI due to left anterior descending coronary artery (LAD) dissection or type 1 STEMI due to atherothrombotic LAD occlusion. Results: The two groups were similar in age, risk factors, comorbidities, and complications. SCAD-STEMI patients more often had Thrombolysis in Myocardial Infarction 3 flow, while type 1 STEMI patients were more often treated with percutaneous coronary intervention and dual antiplatelet therapy. Baseline mean left ventricular (LV) ejection fraction (LVEF) was similar in the two groups (48.0% vs. 48.6%, p = 0.881), but there was a significant difference at the 3-month follow-up, driven by an improvement in LVEF in SCAD-STEMI compared to type 1 STEMI patients (Δ LVEF 10.1 ± 5.3% vs. 1.8 ± 5.1%, p = 0.002). LV global longitudinal strain was slightly improved in both groups at follow-up; however, the improvement was not significantly different between groups (−4.6 ± 2.9% vs. −2.0 ± 2.8%, p = 0.055). Conclusions: The results suggest that female patients with SCAD-STEMI are more likely to experience improvement in LV systolic function than type 1 STEMI patients. 2024 Krljanac, Apostolović, Polovina, Maksimović, Nedeljković Arsenović, Đorđevic, Stanković, Savić, Ušćumlić, Stanković and Ašanin.

Introduction/Objective Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods From the institutional pulmonary embolism registry, 116 patients with submassive PE were identified, and the relation of their outcome to FT was analyzed using the propensity score (PS) adjustment. The primary endpoint was the composite of death, in-hospital cardiopulmonary deterioration, or recurrence of PE. Safety outcomes were updated TIMI non-CABG related major and minor bleeding. Results According to Cox regression analysis, the incidence of composite endpoint was significantly lower in patients treated with FT compared to anticoagulant therapy (AT) only (PS adjusted HR 0.22; 95% CI 0.05–0.89; p = 0.039). But, when patients were stratified into four PS quartiles, only patients in the highest PS quartile that received fibrinolysis, had significantly lower composite event rate than patients treated with AT (HR 0.20; 95% CI 0.01–0.56; p = 0.016). The overall mortality of the study group was 5.2% and there was no significant difference between the treatment groups. Total bleeding was significantly more frequent in FT patients (HR 3.07; 95% CI 1.02–13.29; p = 0.047), but not the major one. Conclusion The use of FT was associated with a better outcome compared to AT in patients with submassive PE, but the benefit was mainly driven from those with highest values of PS, i.e. with the highest baseline risk. The rate of major bleeding was not significantly increased by FT. © 2019, Serbia Medical Society. All rights reserved.

Background/Aim. The prognostic impact of complete atrioventricular (AV) block on the long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) has not been fully determined. The aim of the study was to analyze the incidence and prognostic impact of complete AV block on in-hospital mortality (IHM) and 6-year mortality in STEMI patients treated with primary percutaneous coronary intervention. Methods. The study included 3,044 consecutive STEMI patients. Results. Complete AV block was registered only on admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. A temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. IHM was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9% vs. 3.6%, respectively, p < 0.001. In patients with heart block and inferior infarction, IHM was 13%, whereas IHM was 53% in patients with heart block and anterior infarction. When we analyzed patients discharged alive from the hospital, we also found a significantly higher long-term (6-year) mortality rate in those with complete AV block vs. patients without AV block: 7.8% vs. 3.4%, respectively, p < 0.001. Complete AV block was an independent predictor for IHM and 6-year mortality: IHM [odds ratio (OR) 2.94 95%, confidence interval (CI) 1.23–5.22; 6-year mortality hazard ratio (HR) 1.61, 95%, CI 1.10–2.37]. When subanalysis was performed in patients with inferior STEMI, complete AV block was an independent predictor of IHM and 6-year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of IHM. Conclusion. In analyzed STEMI patients, complete AV block was transitory and was registered only on hospital admission. Although transitory, complete AV block remained a strong independent predictor of IHM and long-term mortality. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.