Faculty of Medicine

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    Item type:Publication,
    Spontaneous Coronary Artery Dissection
    (Department of Anesthesia and Reanimation, Faculty of Medicine, "Ss Cyril and Methodius" University, Skopje, R. N. Macedonia, 2023-04)
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    Bojoski I
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    Jovanoski M
    Spontaneous coronary artery dissection (SCAD) is non-iatrogenic, non-traumatic and nonatherosclerotic separation of the coronary artery wall caused by intramural hematoma development with or without simultaneous co-existence of coronary wall tear. The net effect is compression of the true coronary artery lumen with development of ischemia. SCAD typically occurs in relatively young population, dominantly females (around 90%), often in peripartum, in which there are absent or very rare classical risk-factors for coronary artery disease (CAD). The most frequent clinical manifestation of SCAD is acute coronary syndrome (ACS – STEMI or NSTEMI), rarely cardiogenic shock or life-threatening arrhythmias (VT or VF), and sometimes sudden cardiac death. Diagnosis (which sometimes can be challenging) is dominantly established by coronary angiography, and sometimes modalities of intravascular visualization may be useful (IVUS, OCT). The most of the patients with SCAD are treated conservatively and small proportion of them requires revascularization (PCI or CABG). In addition, we present several cases with SCAD. Conclusion: Timely and accurate diagnosis and treatment is extremely important in SCAD, which is a potentially life-threatening condition.
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    Presentation, care and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology
    (Oxford Academic, 2023-02-03)
    Nadarajah, Ramesh
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    Ludman, Peter
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    Laroche, Cécile
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    Appelman, Yolande
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    Brugaletta, Salvatore
    Background: The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care and outcomes of NSTEMI by country income classification. Methods: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack and death, and 30-day mortality. Results: Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared to patients in HICs, were younger, more commonly diabetic and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; p < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; p = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; p < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; p < 0.001) exhibited an inverse economic gradient. Conclusions: Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.