Bojan Stojanović

Institute for Cardiovascular Diseases of Vojvodina

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Ana Vojvodić

Institute for Cardiovascular Diseases of Vojvodina

Zorana Vasiljević

University of Belgrade

Gordana Krljanać

University of Belgrade

Nataša Mickovski-Katalina

Institute of Public Health of Serbia

Biljana Putniković

Zemun Hospital

Ihor Gussak

Rutgers, The State University of New Jersey

Milika Ašanin

University of Belgrade

Gordana Panić

Institute for Cardiovascular Diseases of Vojvodina

Dejan Vukajlović

Institute for Cardiovascular Diseases of Vojvodina

Z. Vasiljević

Malmö University

Cooperative Institutions

University of Belgrade

Institute for Cardiovascular Diseases of Vojvodina

Univerzitetski Klinički Centar Srbije

Centar za Promociju Nauke

University of Belgrade – Faculty of Medicine

Institut za kardiovaskularne bolesti Dedinje

Grade Medical (Czechia)

University of Novi Sad

Kliničko Bolnički Centar Zvezdara

Institute of Public Health of Serbia

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612 Is TIMI risk score as useful prognostic factor as BNP in STEMI

European Journal of Heart Failure Supplements (2006)

Gordana Krljanać Ana Vojvodić Milika Ašanin S. Stankovic Bojan Stojanović

TIMI

10.1016/s1567-4215(06)80409-1

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Coronary care unit and primary percutaneous coronary intervention networks improve the standard of care: reperfusion therapy in ST elevation myocardial infarction in Serbia from 2002 to 2008

Journal of Cardiovascular Medicine (2011)

Zorana Vasiljević Nataša Mickovski-Katalina Gordana Krljanać Gordana Panić Biljana Putniković

Vasiljevic, Zorana; Mickovski-Katalina, Natasa; Krljanac, Gordana; Panic, Gordana; Putnikovic, Biljana; Ostojic, Miodrag; Stojanovic, Bojan; Milanovic, Sladjan Author Information

Coronary care unit

Elevation (ballistics)

Reperfusion Therapy

ST elevation

10.2459/jcm.0b013e328343e9f2

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Hospital mortality trend analysis of patients with ST elevation myocardial infarction in the Belgrade area coronary care units

Srpski arhiv za celokupno lekarstvo (2008)

Zorana Vasiljević Bojan Stojanović Nikola Kocev Branislav Stefanović Igor Mrdović

INTRODUCTION. Mortality in ST elevation myocardial infarction (STEMI) ranges from 4-24% and is dependent on the variety of patients? clinical characteristics (CC) that are present prior to and within the first hours of the onset of MI, affecting reliability of the diagnosis. The higher mortality rate of patients with STEMI should be associated with a higher rate of applied reperfusion therapy according to guidelines and randomized study results, which is in opposition to everyday hospital practice. OBJECTIVE. The aim of this study was to analyze the mortality of STEMI patients in relationship to their clinical characteristics at presentation, their age, sex, risk factors, prior coronary disease, and time interval from symptom onset to hospital presentation, complications and administered therapy. METHOD. The analysis involved patients treated in five coronary care units, four Belgrade Hospital Centres and the Belgrade Emergency Centre of the Clinical Centre of Serbia. Evaluated data was obtained from the Serbian National Registry for Acute Coronary Syndrome (REAKSS) and databases of local coronary care units (CCU). RESULTS. During 2005 and 2006, a total of 2739 patients with STEMI, of average age 63.3?11.7, with 64.9% males aged 61.3?11.7 and 35.1% females aged 67.0?10.7 (p<0.01) who underwent treatment. Most of the patients (80.5%) were distributed within the elderly groups of 60, 70 and 80 years of age, with the highest percent of mortality rate (45.9%) noted at age 80 years. Anterior localization of myocardial infarction was observed in 40.2% of patients, with lethal outcome in 21.4% patients, while 59.8% of patients suffered inferiorly localized MI with much lower mortality rate (12.2%, p<0.01). In 2005, STEMI was registered in 48.7%, while in 2006 in 44.7% of patients. Prior angina pectoris was present in 19.9% of patients, more frequently among women (p<0.05), prior MI in 14.5% of patients, more often among males (p<0.05), while aortocoronary revascularization was found in 3.9% of patients. Hospital mortality rate due to STEMI was higher in the group of patients with a history of prior MI (19.1% vs. 15.7%; p>0.05). Regarding risk factors, hypertension was present in 61.8% of patients, more often among women (69.1% vs.57.9%) (p<0.01), carrying a higher mortality rate of 18.9% vs. 9.9% among males (p<0.01). Hyperlipidemia was found in 31.9% of patients; more frequently among women 34.8% vs. 30.4% males (p<0.05), as well as diabetes mellitus observed in 25.1% of patients; 22.4 % males and 30.1% females (p<0.01). 39.6% of patients were smokers; 46.9% males and 28.0% females (p<0.01). Heart failure had 33.4% of patients; mortality rate was registered in 28.2% of patients, and was significantly higher than in the non heart failure group (7.9%, p<0.01). Heart rhythm disorders were registered in 21.3% of patients, more frequently involving posterior MI 55.3% vs 44.7% of anterior MI (p>0.05), and was significantly higher among females 23.5% vs. 20.1% in males (p<0.05). In 2005 in Belgrade hospitals, reperfusion therapy (RT) was performed in 34.6% of patients, mostly as thrombolytic therapy (TT) (in 99.0% of patients), and as percutaneous coronary intervention (PCI) in 1.0% of patients. STEMI mortality rate was 12.8%. In 2006, in the CCU of the In the Emergency Center RT was applied in 48.0% of patients, TT in 13.8% and PCI in 34.2%, while classical therapy without RT was applied in 52.0% of patients. CONCLUSION. Clinical characteristics significantly influence mortality in STEMI; a significantly higher mortality is among women, patients in their 80?s and 90?s, anterior MI localization and prior coronary disease. RT significantly lowers mortality in STEMI compared to the use of classical therapeutic approach and therefore STEMI patients with a higher mortality determined by their prehospital charactheristics, i.e. higher risk, are those who have higher benefit of RT, which should be taken into consideration when making decision about the therapy of choice.

10.2298/sarh08s2084v

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64 24 and 72h BNP levels and in-hospital mortality in STEMI

European Journal of Heart Failure Supplements (2006)

Ana Vojvodić Gordana Krljanać Vojislav Giga Milika Ašanin S. Stankovic

10.1016/s1567-4215(06)80030-5

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Clinical characteristics, management and mortality in patients with acute coronary syndrome from 2002 to 2005: Report from the National registry of acute coronary syndrome in Serbia

Srpski arhiv za celokupno lekarstvo (2007)

Zorana Vasiljević Nataša Mickovski-Katalina Gordana Panić Mirjana Krotin Biljana Putniković

Introduction Data regarding patients with acute coronary syndrome (ACS) did not exist in Serbia until 2002. By establishing the National Registry for Acute Coronary Syndrome (NRACS), the data collection based on the filled-in "coronary questionnaire" for each patient hospitalized and diagnosed with acute infarction of the myocardium (AIM) and unstable angina pectoris (UAP) was initiated in Serbia. Objective The aim of the study was to analyze clinical characteristics, complications, applied reperfusion-thrombolytic treatment and standard therapy, and mortality rate of patients treated in coronary or intensive care units during the 2002, 2003, 2004 and 2005. Method We chose a "coronary protocol" with minimal set of the patient?s data that was filled-in by the attending physician. The collection of the data was initiated in July 2002. Results During four months of 2002, 4202 patients were treated for ACS; in 2003 12739 patents, in 2004 12351 patients and 12598 patients in 2005. AIM with ST elevation (STAIM), as related to AIM without ST elevation (NSTAIM), was more often encountered in Serbian population in comparison to other European countries: in 2002, it was registered among 52.3% of patients, in 2003 among 52.7%, in 2004 among 51.8%, and in 2005 among 50.7% of patients. The patients suffering from the ACS in Serbia were of younger age, with a significant prevalence of females, as compared to the data from the European countries. Thrombolytic therapy in STAIM was applied in only 24.5% of patients in 2002, which then rose by each year, to reach 36.4% of patients in 2005. At the same time, as expected, hospital mortality rate decreased: from 14.8% in 2002 to 8.2% in 2005. STAIM patients untreated by thrombolytic therapy had a considerably higher mortality rate: in 2002 it was 20.3%, in 2003 15.3%, in 2004 14.3%, and in 2005 13.8%. Total mortality rate in patients with STAIM gradually decreased from 19% in 2002 to 11.7% in 2005. Conclusion From 2002-2005, the patients treated for ACS in Serbia were younger, with higher prevalence of females, and with a higher incidence of STAIM in relation to NSTAIM. The administration of reperfusion therapy in STAIM patients has been increasing significantly, from 24.5% in 2002 to 36.4% in 2005, and was followed by a decrease in hospital mortality rate of 14.8% in 2002 to 8.2% in 2005. Overall mortality of STAIM patients treated with or without thrombolytic therapy gradually decreased from19% in 2002 to 11.7% in 2005.

Unstable angina

10.2298/sarh0712645v

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Wireless remote monitoring of reconstructed 12-lead ECGs after ablation for atrial fibrillation using a hand-held device

Journal of Electrocardiology (2011)

Ihor Gussak Dejan Vukajlović Vladan Vukčević Samuel George Boško Bojović

Lead (geology)

10.1016/j.jelectrocard.2011.09.003

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Wireless monitoring of reconstructed 12-lead ECG in atrial fibrillation patients enables differential diagnosis of recurrent arrhythmias

Annual International Conference of the IEEE Engineering in Medicine and Biology Society (2011)

Dejan Vukajlović Ihor Gussak S. George Goran Šimić Boško Bojović

Differential diagnosis of symptomatic events in post-ablation atrial fibrillation (AF) patients (pts) is important; in particular, accurate, reliable detection of AF or atrial flutter (AFL) is essential. However, existing remote monitoring devices usually require attached leads and are not suitable for prolonged monitoring; moreover, most do not provide sufficient information to assess atrial activity, since they generally monitor only 1–3 ECG leads and rely on RR interval variability for AF diagnosis. A new hand-held, wireless, symptom-activated event monitor (CardioBip; CB) does not require attached leads and hence can be conveniently used for extended periods. Moreover, CB provides data that enables remote reconstruction of full 12-lead ECG data including atrial signal information. We hypothesized that these CB features would enable accurate remote differential diagnosis of symptomatic arrhythmias in post-ablation AF pts. Methods: 21 pts who underwent catheter ablation for AF were instructed to make a CB transmission (TX) whenever palpitations, lightheadedness, or similar symptoms occurred, and at multiple times daily when asymptomatic, during a 60 day post-ablation time period. CB transmissions (TXs) were analyzed blindly by 2 expert readers, with differences adjudicated by consensus. Results: 7 pts had no symptomatic episodes during the monitoring period. 14 of 21 pts had symptomatic events and made a total of 1699 TX, 164 of which were during symptoms. TX quality was acceptable for rhythm diagnosis and atrial activity in 96%. 118 TX from 10 symptomatic pts showed AF (96 TX from 10 pts) or AFL (22 TX from 3 pts), and 46 TX from 9 pts showed frequent PACs or PVCs. No other arrhythmias were detected. Five pts made symptomatic TX during AF/AFL and also during PACs/PVCs. Conclusions: Use of CB during symptomatic episodes enabled detection and differential diagnosis of symptomatic arrhythmias. The ability of CB to provide accurate reconstruction of 12 L ECGs including atrial activity, combined with its ease of use, makes it suitable for long-term surveillance for recurrent AF in post-ablation patients.

Lead (geology)

10.1109/iembs.2011.6091174

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Obstacles in the diagnostics and therapy of heparin-induced thrombocytopenia

Srpski arhiv za celokupno lekarstvo (2010)

Nebojša Antonijević Nebojša Radovanović Slobodan Obradović D. Vučelić Bojan Stojanović

An immune-mediated, severe, acquired prothrombotic disorder, heparin-induced thrombocytopenia type II (HIT II) occurs in 0.5-5% of patients exposed to unfractionated heparin longer than 5-7 days. Arterial and venous thromboses are induced by HIT II in about 35-50% of patients. Typical death rate for HIT is about 29%, while 21% of HIT patients result in amputation of a limb. The trend towards the occurrence of HIT due to the administration of low molecular weight heparins (LMWH) taking ever conspicuous place in the standard venous thromboembolism (VTE) prophylaxis has been more frequently observed recently. It is considered that LMWH may cause HIT II in about 0.25-1%. The need for further modification of HIPA assays with LMWH has been imposed in the HIT laboratory diagnostics, heretofore overburdened with complexity. There are several constantly opposing problems arising in HIT laboratory diagnostics, one of which is that in a certain number of patients immunologic assays detect nonpathogenic antibodies (mainly IgM or IgA heparin-PF4 antibodies) while, on the other hand, the occurrence of HIT pathogenetically mediated by minor antigens (neutrophil-activating peptide 2 or interleukin 8) may be neglected in certain cases. The following factors play an important role in the interpretation of each laboratory HIT assays performed: 1. correlation with HIT clinical probability test, the best known of which is 4T?score, 2. the interpretation of the laboratory findings dependent on the time of the thrombocytopenia onset, as well as 3. the sensitivity and specificity of each test respectively. The HIT diagnostics in the presence of other comorbid states which may also induce thrombocytopenia, more precisely known as pseudo HIT (cancer, sepsis, disseminated intravascular coagulation, pulmonary embolism, antiphospholipid syndrome, etc), represents a specific clinical problem.

Heparin-Induced Thrombocytopenia

10.2298/sarh10s1069a

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Female coronary artery disease

Arhiv za farmaciju (2005)

Zorana Vasiljević Ana Vojvodić Gordana Krljanać Jelena Janković Bojan Stojanović

Gender-related differences in coronary artery disease is known and have been reported in many studies with acute myocardial infarction (AMI) or angina pectoris. To investigate the data about AMI in female (F) in Serbia we used National CCU Register of AMI from 50 coronary care unit during 2003 There were 8883 pts with AMI: 37.3% and 62.7% men (M). F were older (65.76±10.46) than M (61.06±11.7) p=0.000, with higher incidence of diabetes (P=0.000), hypertension (P=0.000) and obesity (p=0.000). Time from onset of symptoms to arrival in CCU was much longer in F group compared to M , P=0.000. There was not difference between F and M in incidence of ST elevation AMI , but reperfusion therapy was used statistically more in M (24.4%) than in F (15.3%); P=0.000. F presented higher incidence of heart failure (38%) man M (29%) P= 0.000 and mortality was higher in F (18%) than in M (11%). P=0.000. AMI complications as heart failure and mortality in women in Serbia was statistically higher compared to men (M), probably because women are older, with more risk factors and less applied fibrinolityc therapy and longer time for arrival in hospital.

Coronary care unit

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