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    Radial artery anomalies in the Macedonian population during transradial angiography procedures
    (Association of Medical Doctors "Sanamed" Novi Pazar, 2016)
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    Petkoska, Danica
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    Antov, Slobodan
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    Vasilev, Ivan
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    Jovkovski, Aleksandar
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    Item type:Publication,
    Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial
    (Lippincott Williams & Wilkins for the American Heart Association, 2024-12)
    Reynolds, Harmony R
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    Page, Courtney B
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    Shaw, Leslee J
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    Berman, Daniel S
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    Chaitman, Bernard R
    The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
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    Complete transitioning to the radial approach for primary percutaneous coronary intervention: a real-world single-center registry of 1808 consecutive patients with acute ST-elevation myocardial infarction
    (2014-09)
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    Dharma, Surya
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    Antov, Slobodan
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    To compare the short- and long-term outcomes of transradial approach (TRA) versus transfemoral approach (TFA) for primary percutaneous coronary intervention (PPCI) during a complete institutional transition from TFA to TRA.
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    The prevalence and outcomes of transradial percutaneous coronary intervention for acute coronary syndrome. Analysis from the single-centre ISACS-TC Registry (International Survey of Acute Coronary Syndrome in Transitional Countries) (2010-12)
    (Oxford University Press (OUP), 2014-01-01)
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    Antov, Slobodan
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    The aims were to compare the prevalence and short-term outcomes of transradial (TRA) percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in dedicated radial centre. This was a single-centre observational study of 3484 consecutively enrolled patients with ACS in a 3-year period (2010–12). There were 1648 patients with ST-elevation myocardial infarction (STEMI) and 1836 with non-ST-elevation ACS (NSTEACS). All patients underwent diagnostic coronary angiography within 24 h (STEMI) or within 72 h (NSTEACS). Percutaneous coronary intervention was performed in 84.9% patients (96.6% with STEMI and 74.9% with NSTEACS). Optimal medical treatment (OMT) only was recommended to 2.2% with STEMI and to 11.1% with NSTEACS. Coronary artery bypass graft (CABG) surgery was performed for 1.7% of STEMI and 14.1% of patients with NSTEACS (P < 0.0001). Most of the PCI procedures were performed through the wrist access (radial 97% and ulnar artery access 1.3%). There was high overall procedural success 98.5% (STEMI 99% and NSTEACS 97%). At 30 days, cardiovascular mortality was 4.7% in STEMI patients and 1.4% in patients with NSTEACS who were treated by PCI (P < 0.0001). Major adverse cardiac events defined as a composite of death, myocardial infarction, stroke, and non-CABG major bleeding and major access site complications at 30 days were higher in STEMI vs. NSTEACS patients (7.7 vs. 4.4%; P < 0.0001). Transradial access for PCI in a large cohort of unselected patients with ACS, is safe and feasible when performed by experienced radial operators. Patients with NSTEACS are more frequently treated with OMT and have higher referral rate to CABG in comparison with STEMI patients. There is higher 30 day mortality in patients with STEMI.
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    Item type:Publication,
    Macedonia: coronary and structural heart interventions from 2010 to 2015
    (European Association of Percutaneous Coronary Interventions, 2017-05-15)
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    Slobodan Antov
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    The aim of this report is to describe invasive cardiology procedural practice in Macedonia during the period from 2010 to 2015. Details of all consecutive 39,899 patients who underwent cardiovascular, peripheral or structural heart procedures during the period from 2010 until 2015 were examined. Clinical and procedure characteristics, access site, procedural success and complications were analysed. The number of coronary angiographies increased from 5,540 in 2010 to 8,550 in 2015. Transfemoral access (TFA) was present in 4% of coronary angiographies in 2010 and had decreased to 1% in 2015. The number of primary percutaneous coronary interventions (PCI) for acute ST-segment elevation myocardial infarction increased from 763 to 1,175 and both chronic total occlusion and left main coronary artery interventions also increased over time. In 2015, the drug-eluting stent penetration rate was 65%. Structural heart interventions, including transcatheter aortic valve implantations (TAVI) were introduced in 2014 and 23 TAVI cases have since been performed. Transradial access was performed in 38,455 (96%) of all patients. Wrist access adoption in the majority of cardiovascular interventions is possible in all PCI centres in Europe if an appropriate national strategy is developed.
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    Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures
    (Scientific Foundation SPIROSKI, 2022-11-25)
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    AIM: The purpose of the study was to present a new technique of retrograde recanalization of radial artery (RA) occlusion (RAO) in patients with need for repeated wrist access percutaneous angiographic procedures. MATERIALS AND METHODS: During a 10-year period from March 2011–May 2021, 53 000 patients were referred for percutaneous coronary intervention (PCI) in a high-volume transradial center. RAO on angiography was documented in 1165 patients. Retrograde recanalization of RAO was attempted in 70 patients. The selected patients were with multiple previous bilateral wrist interventions (n = 3–9). Ipsilateral ulnar artery was usually rudimented or occluded and contralateral wrist approach could not be used. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and procedural success of retrograde recanalization of RAO. Visual analog scale (VAS) score forearm pain assessment was performed after procedure. Technique: All patients had palpable pulse distal of previous puncture site due to collaterals from ipsilateral ulnar and interosseous artery. The RA was punctured with an inner metallic needle with a plastic cannula. Using retrograde radial angiography performed by injecting contrast through the plastic cannula, the occluded segment was visualized and crossed with different types of hydrophilic chronic total occlusion guide wires. After sheath insertion, balloon dilatation of the occluded RA segment, successful catheterization, and/or percutaneous coronary intervention was performed. Final RA angiography was performed on all patients. RESULTS: Successful retrograde opening of RAO was achieved in 65 out of 70 patients (92%). PCI was performed in 56% of patients through the opened RAO and 5 patients underwent CAS. Procedural success through opened RA was achieved in all 65 patients. Forearm pain during procedure was present in all cases (VAS score 3 ± 2.1). Access site bleeding EASY score 3 and 4 occurred in 6 patients (8.5%). One patient had discharge of embolic material up the arm without clinical consequences. In one patient, we observed dissection of the interosseous artery. Clinical and duplex long-term follow-up with a median of 4.1 years showed patent RA in only 20 patients. There were no registered cases of hand ischemia. About 61% of patients underwent subsequent PCIs, through other alternative access sites. CONCLUSION: Retrograde recanalization of RAO is successful and safe in patients with need of repeated coronary angiography procedures and inability to use other wrist access sites. Puncturing the collateral and performing retrograde radial angiography through the cannula is a key factor in successful opening of the RAO.
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    Item type:Publication,
    SINGLE CENTER REGISTRY OF TRANSRADIAL VERSUS TRANSFEMORAL ACCESS FOR PRIMARY PCI
    (Elsevier BV, 2011-04)
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    Antov, Slobodan
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    Transradial versus transfemoral access for female patients who underwent primary PCI in STEMI: Two years follow-up data from acute STEMI interventional registry
    (Elsevier BV, 2016-08)
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    Sukmawan, Renan
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    Dharma, Surya
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    Antov, Slobodan
    Female patients possess a higher risk for poorer outcome in ST segment elevation myocardial infarction (STEMI). There is possibility that transradial access (TRA) for primary percutaneous coronary intervention (PPCI) could provide better outcome than transfemoral access (TFA) in female patients with STEMI.
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    Prognostic Significance of Echocardiographic Parameters for Right Heart Assessment and Risk of Developing Advanced Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)
    (2023)
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    Nikolovski, Robert
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    Background: Chronic obstructive pulmonary disease (COPD) аaccording to World Health Organization is the third leading cause for early death and disability in 2022. COPD is characterized by persistent airflow limitation that is typically progressive and associated with an enhanced chronic inflammatory response in the airways and lung tissue. As the disease progresses more cardiovascular complication appear such as right ventricular hypertrophy with preserved systolic function, pulmonary artery pressure (which is slightly to moderately increased), and moderate tricuspid regurgitation. Material and methods: The design of our study was a prospective-clinical cross-sectional study. We analyzed 94 patients with COPD. All patients were divided in groups according to degree of obstruction and classified by GOLD classification system into four groups from GOLD 1-GOLD4. In our study all patients during admission and hospital stay were thoroughly examined with anamnesis, physical examination and electrocardiogram (ECG), as well as with basic and advanced echocardiographic assessment.13teen echo parameters were evaluated applying advanced echocardiographic analysis especially in terms of right heart features. Results: All echocardiographic parameters were analyzed to understand their significance in disease progression in patients with COPD and increasing Gold classes. Twelve of 13-teen echo-parameters evaluated in our study have quantitative values, while collapsibility of vena cava >50% is a qualitative parameter. Quantitative values of the same echo-parameters (DA, S TDV DV, TAPSE, FAC, AT a.pulmonalis, SPAP, v.max, MPI DV, Stain DV, DA area, PVR and collapsibility of vena cava > 50 %) were compared in terms of Gold classes by multivariate linear regression analysis. With multivariate linear regression analysis, there is a statistically significant correlation (with the following three echocardiographic parameters: S’ TDV DV, DV basal and Global strain DV according to GOLD classes. In further analyses, binary categorization of GOLD classes into two binary categories was additionally used: lower GOLD classes (1 and 2), and more advanced GOLD classes (3 and 4) by applying logistic regression model. The parameter basal dimension of the right ventricle (RV basal) has the highest values statistically, the parameters SPAP, AT a.pulm, Gl strain of DV and TAPSE have somewhat lower values. Conclusion: Prevalence of pulmonary hypertension has a linear relationship with severity of COPD and severe pulmonary hypertension is almost every time associated with development of right heart failure. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions. We suggest screening of all COPD patients for cardiac complications using echocardiography as a non-invasive and repeatable for their follow-up
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    Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry
    (Oxford Academic, 2022-12-13)
    Nadarajah, Ramesh
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    Ludman, Peter
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    Appelman, Yolande
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    Brugaletta, Salvatore
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    Budaj, Andrzej
    The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.