Faculty of Medicine

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Prognosticators of heart failure in patients after treatment because of acute coronary syndrome
(2016-05)
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Bekim Pocesta
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Gorjan Krstevski
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Hajber Taravari
Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.
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Mid-term clinical outcome of patients treated for acute coronary syndrome-data from the registry
(2016-10)
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Bekim Pocesta
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Taravari Hajber
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Shehu Enes
Aim of the study: what are the prognosticators of mid-term outcome in patients treated because of acute coronary syndrome. Methods: Longitudinal retrospective-prospective single center study that analyze, type of ACS (STEMI/NSTEMI/APNS), hemodynamic parameters (heart rate and SBP on the admition), type of treatment (PCI vs medical), LV ejection fraction, extent and severity of CAD, medication used, medications post discharge, type and time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 364 patients treated for ACS, at mean age 63,1±11,1 y., 246(67,4%) males and 119(32,6%) females, were followed up for mean 18.6±10,4 months. A total of 95 cardiac events (CE) in 94(25,8%) patients during the 364pts./563.7 y. follow up were registered, or 17.6% annually. 8 (2.2%) cardiac deaths (CD) were registered, or 1.5% annually death rate. Ischemic events were the most frequent (59-15,7%): angina-14(3,9%), scheduled revascularization after ACS because of multivassel CAD-31(8.5%), and acute ischemic event leading to re-revascularization-12(3.3%) pts. Symptomatic heart failure-20(5.5%) pts. leading to CD in 5, 7(1,4%), ischemic CVI with one fatal event, atrial arrhythmias in 8(2,2%) and malignant ventricular arrhythmias in 4(1,1%) pts. one with fatal ending, and one sudden CD. 58(61,7%) out of 94 events occurred during the first 6 months after the ACS. Univariate predictors were: medications used: DAPT: beta -2.147, p=0.000, expB 0.117; beta blockers: beta -.952, p=0,004, exp(B) 0,386; BB+RAAS inhibitors: beta -.765, p=0,015, exp(B) 0,465; diuretics: beta 1,189, p=0,007; exp(B) 3.284; ASA prior the first event: beta -1.055, p=0,000; exp(B) 0.345; diabetes: beta .788, p=0.006, exp(B) 2.199; anemia: beta1,090, p=0,006, exp(B) 2.975; age: beta.155, t 2.198, p=0.029; HR beta.155, t 3.274, p=0.001; number of lesions: beta.105, t 2.009, p=0.045; In a backword conditional logistic regression model six independent predictors were identified: ASA prior the first event exp(B) .537, p=0.049; DAPT exp(B) 2.245, p=0.000; BB+RAAS exp(B) .492, p=0.046; diuretics exp(B) 3.087, p=0.18; DM exp(B), p=0.014; Conclusion: The prevalence of CE during the mid-term follow up in ACS patients was 17.6%, with 1.5% death rate annually. Diabetes is a powerful independent predictor of mid-term outcome in patients treated for ACS. But taking aspirin therapy prior to the event, DAPT, combined BB+RAAS inhibitor after the treatment for ACS are significant positive prognosticators, as opposite taking diuretic therapy is a negative prognosticator of mid-term outcome in these patients.
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Incidence of Major Gastrointestinal Bleeding in Patients with Acute Coronary Syndrome treated with dual antiplatelet and anticoagulant therapy-Data from the Registry.
(2017)
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Bekim Pocesta
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Hajber Taravari
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Shehu Enes
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Kitanoski Darko
Aim of the study: To investigate the incidence, predictors and prognosis of gastrointestinal bleeding in patients treated for acute coronary syndrome. Materials and Methods: A retrospective study with data gathered from the registry. We analyzed different variables of STEMI, NSTEMI and unstable angina treated patients: clinical, angiographic, treatment type, medications use, in-hospital outcome. Upper gastrointestinal bleeding was defined as hematemesis and/or melena with Hgb reduction, requiring cessation of antiplatelet or anti-coagulant therapy and administration of erythrocyte transfusion and, if needed, upper GIT endoscopy. Statistical Analysis: Descriptive, comparative, univariate and multivariate linear and/or binary logistic regression analysis. Statistical significance was determined at a 0,05 level. Results: 874 patients (66,6% males and 33,4% females, mean age 65,7 ± 11,04 y) were analyzed. 75,4% of the patients had STE-MI, 12.5% had NSTEMI and 12,1% APNS. The predominant risk factors were: HTA (59.9%), smoking (56,9%), overweight/obesity (66,7%) and DM (27,8%). 11% had previous MI, 11,3% revascularization, 5,3% CVI and 5% had previous GIT symptomatology. Mean eGFR was 93 ml/min, although 16,4% of the patients had eGFR < 60ml/min. Preexisting anemia was registered in 9,7%. 93,6% of STEMI, and 91,6% of NSTEMI/APNS patients received PCI. Regarding the patients medications, 98,4% were treated with ASA, 70% with 600 mg loading dose Clopidogrel, 90,4% with UFH and 18% received H 2 blockers or PPI. For the in-hospital morbidity, 5,6% of the patients had acute heart failure, 2,8% A-V block, 2,6% acute renal failure, 5,4% supraventricular arrhythmias, 6,4% ventricular arrhythmias, 0,8% in-stent thrombosis, and 0,3% of the patients had ischemic CVI. The most frequent bleeding complications were: 9,2% at the vascular access site, 1,5% GI bleedings and 1,6% UG bleedings. Hospital mortality was 6,8%, and the death Hazard Ratio among patients with GIB was 9,34 (CI 2,95-29,5). Univariate predictors of GIB were: age (beta ,085), BMI (beta-,073), eGFR < 60ml/min (beta-,081), Crusade bleeding risk score (beta ,141), Hgb (beta-,225), urea (beta ,386), old MI (OR 3,715), GPIIb/IIIa inhibitors (OR 9,267), H2/PPI (OR 10,840), anemia (OR 11,712), eGFR < 60 ml/min (OR 6,390), ARF (OR 7645), and supraventricular arrhythmias (OR 5,440). Previous MI (p = 0,010), use of GPIIb/IIIa inhibitors (p=0,031); H2 or PPI (p = 0,000); eGFR < 60 ml/min (p = 0,050); supraventricular arrhythmias (p = 0,002), and anemia prior ACS (p = 0,042) were identified as independent predictors. Conclusion: GIB is one of the most frequent bleeding complications in patients treated for acute coronary syndrome, associated with a significant in-hospital mortality risk.
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QT prolongation, QT dispersion and ventricular arrhythmias in patients with acute coronary syndrome treated with percutaneous coronary intervention
(2018-03)
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Bekim Pocesta
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Taravari Hajber
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Bojovski Ivica
The QT interval prolongation which happens during acute coronary syndrome is a dynamic parameter which changes at different points-reaches the peak point 24h after PCI and gets back in the normal range after 72h. QT dispersion follows this trend of change as well. Theres no difference of these changes between patients who present with STEMI, and patients with NSTEMI, except for the value of QT dispersion at admission which is shorter in the STEMI group. These patients have increased risk of malignant arrhythmias and should be closely monitored

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