Faculty of Medicine

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The Paradox of SMURF-less Outcomes and its Implication for Diabetes
(Oxford University Press (OUP), 2026-01-28)
Cenko, Edina
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Manfrini, Olivia
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Yoon, Jinsung
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Bergami, Maria
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Vasiljevic, Zorana
Individuals without standardized modifiable risk factors (SMuRF), which implicitly include those with diabetes, have been paradoxically reported to experience higher mortality following acute coronary syndromes (ACS). We aim to clarify the independent impact of diabetes on 30-day mortality after ACS and explore how grouping it with other SMuRF might obscure its true effect.
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Perioperative Outcomes of the Laparoscopic Treatment for Colorectal Cancer at the Clinic for Digestive Surgery Skopje, in a 5-Year Interval
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2022)
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Colorectal cancer (CRC) is the third leading cause of cancer related death in the world, and its incidence is rising in developing nations. Taking into account the increase in the incidence of this disease, the purpose of this review was to evaluate perioperative outcomes (in the first 30 days after surgery) for laparoscopic treatment of this malignancy, a treatment that is steadily becoming standard of patient care in the world. Our review showed that at the Clinic for Digestive Surgery, from 2015 to 2019, 115 patients with colorectal cancer were treated laparoscopically. The figures show a growing trend during this period. 10% of all colorectal cancers in 2019 were completed laparoscopically. In most cases (88.7%) tumor staging was pT2 and pT3. Perioperative outcomes showed wound infection in 2 patients, pulmonary complications in 1, anastomotic leakage in 1, bleeding in 1 patient, no readmission, and no mortality. The rate of conversion to open access is 5.7%, the operating time was 198 minutes on average, the average number of hospital stays was 9 days, and the average number of extirpated lymph nodes 13. There was no need for blood transfusion. Perioperative results for laparoscopic treatment of colorectal cancer at our institution show a low morbidity and mortality rate in these patients, with a clearly rising number in laparoscopically operated patients each year. Long term results are yet to be seen. Follow up with these patients will provide results later.
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Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
(Macedonian Academy of Sciences and Arts/De Gruyter, 2023-12-01)
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Milenkova, Mimoza
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Vasileva, Adrijana Spasovska
Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 - 0.958, p = 0.000; OR 0.987; 95%CI: 0.885-0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
(Oxford University Press (OUP), 2022-08)
Proietti, Marco
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Romiti, Giulio Francesco
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Vitolo, Marco
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Harrison, Stephanie L
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Lane, Deirdre A
Background: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Transition Towards Transradial Approach Improves Outcomes of Acute Myocardial Infarction PCI
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2017-09-01)
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Antov, Slobodan
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Kalpak, Gjorgji
Introduction and aim: Transradial (TRA) instead of transfemoral (TFA) approach strategy has been presented in research literature as superior access strategy especially for acute ST elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI). There is a paucity of registry-based data of outcomes from default TRA strategy compared to TFA. Materials and methods: All-comers STEMI PCI institutional Registry identified 1808 consecutive patients in time-frame of 40 months from 2007 to 2010, without making any exclusions. Moreover, we applied Propensity Score Matching (PSM) to replace randomization, address the potential confounding and selection bias. PSM derived 565 congruent pairs of patients from the groups. Results: After 30 days the primary composite endpoint of major adverse cardiovascular events (MACE) was in favor of TRA 6.5% vs. 12.4% in TFA group, simultaneously secondary endpoints of death in TRA with rate of 4.8% and with rate of 10.1% in TFA. Moreover, the rate of major access related bleeding was 1.1% in TRA vs. 8.5% in TFA, in contrast the major non-access related bleeding was 1.8% and 2.4% respectively showed no significant difference. One year Kaplan Meier survival plots were in favor of TRA. Conclusions: Default transradial access strategy is associated with improved STEMI PCI outcomes.
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Sex Differences in Heart Failure Following Acute Coronary Syndromes
(Elsevier BV, 2023-05)
Cenko, Edina
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Manfrini, Olivia
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Yoon, Jinsung
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van der Schaar, Mihaela
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Bergami, Maria
BACKGROUND There have been conflicting reports regarding outcomes in women presenting with acute coronary syndrome (ACS).OBJECTIVES The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation.METHODS This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes (ISACS Archives-NCT04008173). Acute HF was defined as Killip classes $2. Participants were stratified according to ACSpresentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale. RESULTS A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio (RR): 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR:1.18; 95% CI: 1.09-1.28; P interaction < 0.001). Acute HF was more common in women when compared to men with STEMI(RR: 1.24; 95% CI: 1.20-1.29) but not in those with NSTE-ACS (RR: 1.02; 95% CI: 0.97-1.08) (P interaction < 0.001). The presence of acute HF increased the risk of mortality for both sexes (odds ratio: 6.60; 95% CI: 6.25-6.98).CONCLUSIONS In patients presenting with ACS, mortality is higher in women. The presence of acute HF at hospital presentation increases the risk of mortality in both sexes. Women with STEMI are more likely to present with acute HFand this may, in part, explain sex differences in mortality. These findings may be helpful to improve sex-specific personalized risk stratification. (JACC Adv 2023;-:100294) © 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open-access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) (14) (PDF) Sex Differences in Heart Failure Following Acute Coronary Syndromes. Available from: https://www.researchgate.net/publication/370306869_Sex_Differences_in_Heart_Failure_Following_Acute_Coronary_Syndromes [accessed Jun 23, 2023].

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