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Author: search.filters.author.Dobjani, AHas files: Yes

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    The role of pre-existing renal dysfunction on in-hospital morbidity and mortality in patients with acute coronary syndrome
    (Oxford University Press (OUP), 2024-04)
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    Bogevska, I
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    Dobjani, A
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    Shehu, E
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    Taravari, H
    Introduction The baseline renal function is an important predictor for the prognosis of patients with acute coronary syndrome (ACS). The aim of our study was to analyse the impact of pre-existing renal failure (RF) and the risk profile of patients with ACS on the development of in-hospital morbidity and mortality. Materials and methods This was a single-center cross-sectional cohort study on 2702 patients with ACS. The main exclusion criterion was pre-existing left ventricular (LV) dysfunction. Demographical and clinical characteristics, biochemical parameters, the anatomical distribution of coronary artery disease, and the final outcomes were analysed according to presence of RF at the moment of the index event. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease Study Group Equation (MDRD), where patients with eGFR<60 ml/min/1.73 m2 had moderate to severe renal dysfunction. Results 777 (22.3%) out of 2702 patients had eGFR <60 ml/min at the moment of the index event. These patients were predominantly female, 34.1% (333) vs.17.7% (444), p=0.0004,OR 1.921(95%CI 1.701-2.168);older (70.0±9.7vs.60.5±10.7;p <0.000). They had significantly higher values of cardiac troponin (p=0.007), stress glycemia (p=0.000019), glycated hemoglobin (p=0.000012), and WBC (p=0.00001), meaning the extent of myocardial injury was bigger, with a more activated neuro-hormonal and inflammatory response in the conditions of the notably widespread anatomical distribution of CAD. However, patients with significantly reduced eGFR were less likely to be offered coronary angiography and PCI treatment, OR 0.524 (95%CI 0.434–0.632),p <0.000. As expected, anemia predominated in these patients (RBC 4.88±0.75 vs 4.53±0.58, p=0.000001; OR 1.27 (95% CI 1.09-1.48), and Hgb 143.81±16.69 vs 132.03±21.34, p=0.00001). They had a significantly lower level of sodium (p=0.008) and a higher level of potassium (p=0.00003). Interestingly, patients with eGFR <60 ml/min had lower lipoprotein levels. In-hospital mortality rate was 4.2%, however, significantly higher in reduced eGFR group (12% vs 1.9%, OR 6.9 (95% CI 4.9–9.8), p <0.00004). These patients were more likely to develop acute kidney injury [25.7% vs. 1.3%, OR 1.6 (95% CI 1.3-1.9, p = 0.000021)], pulmonary oedema [8% vs. 1.8%, OR 1.12 (95% CI 1.02-1.23, p = 0.000021), and cardiogenic shock [19.5% vs. 2.6%, OR 1.22 (95% CI 1.2-1.4), p = 0.00023]. Independent variables associated with RF were: advanced age, female gender, extracardiac ASCVD, previous CVI, previous RAAS treatment, stress glycemia, triglyceride, cholesterol, LDL-C, Hgb, WBC, and potassium level. Conclusion Patients with reduced eGFR (<60 ml/min) have a very specific risk profile, as identified in our study, and reduced eGFR is a major contributor to the prognosis of ACS, highly responsible for in-hospital morbidity and mortality.
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    Left ventricular systolic function in patients with acute coronary syndrome-risk profile
    (Oxford University Press (OUP), 2024-04)
    Dobjani, A
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    Bogevska Naumovska, I
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    Shehu, E
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    Taravari, H
    Introductions and objectives Left ventricular (LV) systolic dysfunction is one of the most important determinants of long-term outcome in acute coronary syndrome (ACS). Aim To determine the impact of the patient’s risk profile on the LV systolic function. Methods A single-center cross-sectional cohort study that included 3093 patients with ACS without pre-existing LV dysfunction. The comparison was performed between patients who did or did not develop a reduction in LV systolic function during the index event (<50%/≥50%), analyzing patients’ demographic, clinical, biochemical data, LV functional data, and anatomical distribution of the coronary artery disease (CAD). Result 1369 patients out of 3093 developed LV systolic dysfunction (44.3%). They were predominantly males 75.1% (1028), p=0.002; older (63.39±11.04 vs 61.21±11.12, p<0.00000); had higher level of cardiac troponin (p=0.00002), higher stress glycemia (9.2±5.3; p=0.0000001), HbA1c (6.9±1.8, p=0.000003), WBC (11.7±4.1, p=0.00001), blood urea nitrogen (BUN) (6.8±3.7, p=0.000003), and creatinine (93.2±45.1 p=0.000167), and had anemia (OR 0.35 (CI 0.29–41, p=0.000012). They had more severe CAD (SINTAX score 16.8±8.4 p=0.000012). Patients with preserved LV systolic function were predominantly females (29.7%, OR 1.1 95% CI 1.0-1.2), p = 0.002), younger (p<0.00000), and severely metabolically burdened (hypothyreosis (2.7%, OR 1.28 95% CI 0.93-1.76, p=0.052), higher levels of triglycerides (2.2±1.7 vs 1.9±1.5, p = 0.001), cholesterol (5.3±1.4 vs 5.2±1.4, p = 0.002), non-HDL-C (4.1±1.5 vs 3.9±1.3, p=0.006), however less likely to have pre-existing DM (OR 0.8 (CI 0.78–0.92), p=0.000094). They were more often NSTEMI [851 (49.4%), p = 0.000012]. Independent variables associated with a reduction in LV function were: advanced age, male gender, previous DM and anemia, stress glycemia, WBC, creatinine, and BUN. Conclusion Patients who developed reduced LV function had a very specific risk profile with bigger neuro-hormonal activation and inflammation, higher degree of myocardial damage, and worse renal function, whereas those with preserved LV systolic function after ACS were younger, predominantly females, more severely metabolically burdened, more often with NSTEMI and without LAD involvement.
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    Acute kidney injury in patients with acute coronary syndrome - risk profile
    (Oxford University Press (OUP), 2024-04)
    Bogevska-Naumovska, I
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    Dobjani, A
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    Shehu, E
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    Taravari, H
    Introduction Acute kidney injury (AKI) is a strong predictor of in-hospital adverse outcomes, which is a common complication of acute coronary syndrome (ACS). Aim To analyse the risk profile of patients treated for acute coronary syndrome who develop acute kidney injury. Material and methods This is a single-centre cross-sectional cohort study on 3507 patients with ACS. The main exclusion criteria was left ventricular dysfunction. Demographical and clinical characteristics, biochemical parameters, the anatomical distribution of coronary artery disease (CAD) and the final outcomes were analysed according to RF at the moment of the indexed event. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease Study Group Equation (MDRD), where patients with eGFR<60ml/min 1.73 m2 had moderate to severe renal dysfunction. Results 74 (2.1%) out of 3507 patients developed acute kidney injury (AKI). Those were predominantly males [62.2% (46), OR 1.55 (95% CI 0.98-2.47), p=0.044], significantly older (68.95±9.9. vs 62.5±11.2; p <0.000001), more often with preexisting HBI (OR 4.72 (95% CI 2.20-10.30, p=0.000070), HTA(OR 1.89 95%CI 1.11-3.23, p=0.020), diabetes(OR 1.88 95%CI 1.18-3.00, p=0.008), cancer(OR 2.92 95%CI 1.15-7.44, p=0.024), anaemia (beta -.104, p=0.000032), while less often were smokers (OR 0.51, 95% CI 0.31-0.83, p=0.006). They had statistically significantly higher values of cardiac troponin (beta .075, p=0.000011), stress glycemia (beta .104, p=0. 0.000019), and WBC (beta .074, p=0.000013), higher BUN (beta .325, p=0.000011), creatinine (beta .268, p=0.000016), and lower eGFR at admission (beta -.211, p=0.000032), lower sodium (beta -.101, p=0.000012), and higher potassium levels (beta .087, p=0.0008). Vice versa, total cholesterol, LDL-C and non-HDL-C (beta -.051, p=0.002, -.049, p=0.003, and -.047, p=0.005 respectively), were lower, the same for Hgb (beta -.107, p=0.000021). It is worth mentioning that 18(11.5%), of AKI patients were not PCI treated. Independent variables associated with AKI were: preexisting renal failure, cancer, and WBC. Outcomes: AKI carried a significantly higher in-hospital mortality rate (4.2% in general population, and 21.1% of all deaths were AKI patients, OR 23.01 (95% CI 14.04-47.03, p=0.00002)]. It was significantly associated with the development of pulmonary oedema (OR 17.94, 95% CI 9.67-33.26, p=0.000012), cardiogenic shock (OR 21.59, 95% CI 12.79-36.47, p=0.00006), any type of dysrhythmia (OR 1.83, 95%CI 1.53-2.18, p=0.0001), and any type of bleeding complications (OR 1.61, 95%CI 1.14-2.27, p=0.007). Conclusion AKI is a relatively rare complication in ACS patients, however, it is associated with significant in-hospital morbidity and mortality. Patients with pre-existing renal failure, and cancer, as well as patients who developed more pronounced inflammatory reactions, were more prone to AKI.