Faculty of Medicine

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    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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    Prevalence of standard modifiable cardiovascular risk factors in patients with ST segment elevation myocardial infarction and its relation with outcomes
    (Oxford University Press (OUP), 2022-10-01)
    Bergami, M
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    Simovic, S
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    Cenko, E
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    Davidovic, G
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    Background: It has been recently suggested that more than 15% of patients with ST-segment–elevation myocardial infarction (STEMI) lack any of the standard modifiable risk factors (cigarette smoking, diabetes, hyperlipidemia, and hypertension -SMuRFs). This claim implies that other factors play a significant role in development of STEMI and has led to considerable interest in genetic causes of coronary heart disease including family history (FHx) Purpose: To investigate whether FHx may be a significant driver for STEMI in patients without SMuRFs. Methods: We analyzed 11,840 patients with ACSs, without evidence of prior cardiovascular disease (CVD) enrolled in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry between January 2010 to January 2021. Main outcome measures were the adjusted rates of STEMI and 30-day mortality from STEMI using multivariable logistic regression models. Patients presenting with non-ST elevation acute coronary syndromes served as controls. Results: Among patients with STEMI, at least 1 of the 4 conventional risk factors was present in 88.1% of women and 86.7% of men. Overall, 3,194 patients (27.0%) self-reported a FHx of CV disease, defined as a firstdegree relative with premature CV events (men, age <55 years; women, age <65 years). There were 261 (8.2%) patients with FHx but without SMuRFs and 2,933 (91.8%) patients with FHx and SMuRFs. After adjusting for age, and standard risk factors, FHx was associated with a significantly lower incidence of STEMI in patients with SMuRFs, but not in those without SMuRFs (ORs: 0.87; 95% Cl: 0.79 to 0.97 vs 0.80; 95% Cl: 0.58 to 1.12). Prior use of evidence-based medications (aspirin, beta-blockers, ACE inhibitors/ARBs and statins) did not consistently change prior estimates on FHx and SMuRFs (OR: 0.82 95% Cl: 0.71 to 0.96 and OR 0.89 95% CI: 0.54–1.47). Patients who presented with STEMI had a 46% excess risk of 30-day mortality (OR: 1.46; 95% CI: 1.11 to 1.91; p<0.001) compared with controls Conclusions: In direct contrast with recent findings, almost 90% of patients with STEMI have SMuRFs. Self-reported FHx is not a significant risk factor for development of STEMI and related high rate of CV mortality in patients without SMuRFs. Although research on genetic causes of heart disease is important, public health policies, and research efforts should place significant emphasis on the 4 SMuRFs and the lifestyle behaviors causing them to reduce the epidemic of STEMI.
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    Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI
    (Elsevier, 2020-11-17)
    De Luca, Giuseppe
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    Verdoia, Monica
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    Cercek, Miha
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    Jensen, Lisette Okkels
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    The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.
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    Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry
    (Springer Science and Business Media LLC, 2020-12-18)
    De Luca, Giuseppe
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    Cercek, Miha
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    Jensen, Lisette Okkels
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    Calmac, Lucian
    It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.
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    Acute Myocardial Infarction with St-Segment Elevation: To Aspirate or Not?
    (MedCrave, 2017-03-17)
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    Paljoshkovska-Jordanova S
    Acute myocardial infarction with ST-segment elevation (STEMI) is the most serious clinical manifestation of acute coronary syndrome (ACS). Golden therapeutic approach for patients with STEMI is primary percutaneous coronary intervention (PCI) and its aim is to restore normal coronary flow and provide myocardial tissue reperfusion as soon as possible leading to myocardial salvage. Thrombus aspiration is an adjunctive therapeutic modality to conventional PCI which can be especially powerful and helpful in some clinical subsets of STEMI with large thrombus burden. Here we discuss about advantages and disadvantages of the thrombus aspiration technique in regard to the most important clinical trials.
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    5993 Radial vs. Ulnar artery anomalies in STEMI patients: 6 year results from routine Wrist artery angiography
    (Oxford University Press (OUP), 2017-08-01)
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    Petkoska, D.
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    Vasilev, I.
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    Jovkovski, A.
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    Taravari, H.
    Objective: To assess and compare the rates of wrist artery anomalies and their impact on the success of STEMI procedures in a large series of patients. Methods: All consecutive 4303 STEMI patients, in the period from March 2011 until December 2016 were examined. Preprocedural wrist artery angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, transfer and procedure time were analyzed. Results: From 4303 STEMI patients, RRA was done in 4169 (96%) patients, transulnar in 80 (1,7%) patients, LRA with 37 (0,8%), TFA in 8 (0,17%) and TBA in 9 (0,2%)patients. Anatomical variants of the RA and UA were present in 432 (10%) STEMI patients. 330 (7,6%) STEMI patients had Radial artery anomalies and 102 (2,4%) had Ulnar artery anomalies on wrist angiography. The most frequent variant in both groups was high-bifurcating radial and ulnar artery origin from the axillary and brachial arteries in 304 (7,1%) patients, with 230 (5,3%) and 74 (1,8%) respectively. From RA anomalies 43 (1,0%) patients had a full radial loop and 57 (1,3%) had extreme radial artery tortuosity. None of the patients had UA loop and UA tortuosities were present in 0,6% (28) patients. Highest incidence of of cross-over was present in patients with complex radial artery loop 16/43 (37%). No UA anomaly in the 80 patients with TUA required access site crossover to another approach. TUA had more punctures with 7% of patients with multiple punctures compared with TRA with only 1%. Conclusion: The ulnar artery has a significantly smaller percentage of anomalies than the radial artery with a low percentage of access crossover in STEMI patients. Pre-procedural wrist artery angiography in STEMI patients gives the operator an opportunity to successfully plan the strategy for crossing the anomaly or transfer to a new approach in the interest of saving time and reducing door to baloon time.