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Dive into the research topics where Miloje Tomasevic is active.

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Featured researches published by Miloje Tomasevic.


Journal of Interventional Cardiology | 2012

Efficiency, safety, and long-term follow-up of retrograde approach for CTO recanalization: initial (Belgrade) experience with international proctorship.

Sinisa Stojkovic; George Sianos; Osamu Katoh; Alfredo R. Galassi; Branko Beleslin; Vladan Vukcevic; Milan Nedeljkovic; Goran Stankovic; Dejan Orlic; Milan Dobric; Miloje Tomasevic; Miodrag Ostojic

BACKGROUND  Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO) of coronary arteries. OBJECTIVES  The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up. METHODS  The study was a single center retrospective registry which included a total of 40 patients, of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization. RESULTS  Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients, retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients, and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients. The success rate of these strategies was: 87.0% (20/23 patients) for primary, 87.5% (7/8 patients) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients) for retrograde after previous failed antegrade attempt, respectively. Total in-hospital major adverse cardiac events (MACE) rate was 5.0% (2 non-Q-wave myocardial infarctions). The MACE free survival at median follow-up of 20 months was 89% (95% CI: 78-100%). CONCLUSIONS  This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long-term survival rate.


Catheterization and Cardiovascular Interventions | 2009

Systemic rapamycin without loading dose for restenosis prevention after coronary bare metal stent implantation

Sinisa Stojkovic; Miodrag Ostojic; Milan Nedeljkovic; Goran Stankovic; Branko Beleslin; Vladan Vukcevic; Dejan Orlic; Aleksandra Arandjelovic; Jelena Kostic; Miodrag Dikic; Miloje Tomasevic

Objectives: The aim of this study was to assess the role of short oral administration of rapamycin, without loading dose, in the reduction of restenosis rate after bare metal stent implantation. Background: Previous studies suggest that the administration of oral rapamycin reduces angiographic restenosis after bare metal stent implantation. Methods: This was prospective, open‐label study of 80 patients randomized to either oral rapamycin (2 mg/day for 30 days, starting within 24 hr of stent implantation) or no therapy after implantation of a coronary bare metal stent. The primary study end point was incidence of angiographic binary restenosis and late loss at six months. The secondary end points were target lesion revascularization (TLR), target vessel revascularization (TVR), and incidence of major adverse cardiovascular events (MACE) at 6 months. Results: Angiographic follow up was completed in 72/80 (90%) of patients. In the rapamycin group, the drug was well tolerated (22.5% minor side effects) and was maintained in 100% of patients. At six months, the in‐segment binary restenosis was 10.5% in rapamycin group vs. 51.4% in no‐therapy group, P < 0.001) and the in‐stent binary restenosis was 7.9% in rapamycin group vs. 48.7% in no‐therapy group, P < 0.001. The in‐segment late loss was also significantly reduced with oral therapy (0.29 ± 0.39 vs. 0.86 ± 0.64 mm, respectively, P < 0.001). Similarly, after six months, patients in the oral rapamycin group also showed a significantly lower incidence of TLR and TVR (7% vs. 22.7%, respectively, P = 0.039) and MACE (7% vs. 22.7%, respectively, P = 0.039). Conclusions: This study showed that the administration of oral rapamycin (2 mg/day, without loading dose) during 30 days after stent implantation significantly reduces angiographic and clinical parameters of restenosis.


Journal of The American Society of Echocardiography | 2011

Prediction of Myocardial Functional Recovery by Noninvasive Evaluation of Basal and Hyperemic Coronary Flow in Patients with Previous Myocardial Infarction

Ana Djordjevic-Dikic; Branko Beleslin; Jelena Stepanovic; Vojislav Giga; Milorad Tesic; Milan Dobric; Sinisa Stojkovic; Milan Nedeljkovic; Vladan Vukcevic; Nenad Dikic; Zorica Petrasinovic; Ivana Nedeljkovic; Miloje Tomasevic; Bosiljka Vujisic-Tesic; Miodrag Ostojic

BACKGROUND The aim of this study was to evaluate the relation of basal and hyperemic coronary flow with myocardial functional improvement in patients with previous myocardial infarction undergoing elective percutaneous coronary intervention (PCI). METHODS Coronary flow was measured using transthoracic Doppler echocardiography in 50 patients (41 men; mean age, 53 ± 8 years) with previous myocardial infarction before, 24 hours, and 3 months after elective PCI. Diastolic deceleration time (DDT) was measured from the peak diastolic velocity to the point of intercept of initial decay slope with baseline. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to basal peak diastolic flow velocities. RESULTS In comparison with patients without improvements in left ventricular function, patients with recovered left ventricular function had longer DDTs before angioplasty (841 ± 286 vs. 435 ± 80 msec, P < .001). CFR was significantly higher in recovered compared with nonrecovered patients (2.60 ± 0.70 vs. 2.16 ± 0.34, P = .034) 24 hours after PCI. Global and regional wall motion scores before PCI, end-diastolic and end-systolic volumes, and CFR 24 hours after PCI and DDT before PCI were univariate predictors of left ventricular functional recovery. By multivariate analysis, DDT and regional wall motion score before PCI were independent predictors of left ventricular recovery in the follow-up period (P = .003 and P = .007, respectively). CONCLUSIONS In patients with previous myocardial infarction undergoing elective PCI, evaluation of basal coronary flow pattern and measurement of DDT before angioplasty may predict functional improvement of myocardium in the follow-up period and could be useful quantitative parameters in the evaluation of potential improvement in myocardial function.


Acta Cardiologica | 2011

Stenting a myocardial bridge: a wrong decision in STEMI?

Miloje Tomasevic; Miodrag Dikic; Miodrag Ostojic

In a STEMI setting, stent implantation for a myocardial bridge (MB) with signifi cant systolic compression in the mid LAD, is a challenging issue. The risk of coronary rupture during stent implantation arises from: (i) a thin intima of the bridged artery; (ii) a thin myocardial layer toward the right ventricle; (iii) a smaller LAD diameter in the MB; (iv) high infl ation pressure in the balloon. Perforation with a coronary fi stula resolving spontaneously within several months is one of the possible scenarios. We report a case of a coronary fi stula between mid LAD and right ventricle after MB stenting in a patient with STEMI, with spontaneous angiographic deterioration after several days. Stent graft implantation in case of a coronary fi stula with increasing fl ow is an eff ective therapeutic concept.


Cardiology Journal | 2014

Regional differences among female patients with heart failure from the Cardiac Insufficiency BIsoprolol Study in ELDerly (CIBIS-ELD)

Svetlana Apostolovic; Dragana Stanojevic; Mitja Lainscak; Goetz Gelbrich; Ruzica Jankovic-Tomasevic; Milan Pavlovic; Danijela Djordjevic-Radojkovic; Sonja Salinger-Martinovic; Biljana Putnikovic; Slavica Radovanović; Finn Waagstein; Miloje Tomasevic; Elvis Tahirovic; Simone Inkrot; Lindy Musial-Bright; Hans-Dirk Düngen

BACKGROUND The aim of our study was to examine regional differences in the demographics, etiology, risk factors, comorbidities and treatment of female patients with heart failure (HF) in the Cardiac Insufficiency BIsoprolol Study in ELDerly (CIBIS-ELD) clinical trial. METHODS AND RESULTS One hundred and fifty-nine female patients from Germany and 169 from Southeastern (SE) Europe (Serbia, Slovenia and Montenegro) were included in this subanalysis of the CIBIS-ELD trial. Women comprised 54% of the study population in Germany and 29% in SE Europe. German patients were significantly older. The leading cause of HF was arterial hypertension in German patients, 71.7% of whom had a preserved ejection fraction. The leading etiology in SE Europe was the coronary artery disease; 67.6% of these patients had a reduced left ventricular ejection fraction (34.64 ± 7.75%). No significant differences were found in the prevalence of traditional cardiovascular risk factors between the two regions (hypertension, diabetes, hypercholesterolemia, smoking and family history of myocardial infarction). Depression, chronic obstructive pulmonary disease and malignancies were the comorbidities that were noted more frequently in the German patients, while the patients from SE Europe had a lower glomerular filtration rate. Compared with the German HF patients, the females in SE Europe received significantly more angiotensin converting enzyme inhibitors, loop diuretics and less frequently angiotensin receptor blockers and mineralocorticoid receptor antagonists. CONCLUSIONS Significant regional differences were noted in the etiology, comorbidities and treatment of female patients with HF despite similar risk factors. Such differences should be considered in the design and implementation of future clinical trials, especially as women remain underrepresented in large trial populations.


Serbian Journal of Experimental and Clinical Research | 2017

Update of Antiplatelet Therapy in Patients Without Known Cardiovascular Disease

Miloje Tomasevic; Srdjan Aleksandric; Sinisa Stojkovic

Abstract Platelet activation and aggregation play a critical role in thrombosis, a fundamental pathophysiologic event responsible for the acute clinical manifestations of atherothrombotic events such as acute coronary syndrome, myocardial infarction, ischemic stroke/transient ischemic attack and peripheral artery disease. Dual antiplatelet therapy (low-dose aspirin plus ADP-P2Y12 receptor blockers) has become the cornerstone of therapy for the management of acute and chronic coronary artery disease and the prevention of ischemic complications associated with percutaneous coronary intervention. However, dual antiplatelet therapy in primary prevention of cardiovascular disease in patients without known cardiovascular disease did not significantly reduce the risk of cardiovascular events, such as myocardial infarction, stroke or death, but significantly increased the rate of bleeding. Furthermore, despite multiple randomized controlled trials evaluating the efficacy and safety of aspirin use in patients without known cardiovascular disease, its role in primary prevention is still unclear, especially in patients with a higher risk of cardiovascular disease (non-diabetic individuals with >2 risk factors for coronary artery disease, elderly >60 years with additional risk factors, and patients with diabetes). Currently, there are four ongoing randomized controlled trials aiming to fill the missing gap in the efficacy and safety of aspirin therapy for primary prevention in these patients. The current European and United States Guidelines agree that primary prevention of cardiovascular disease is essential, but there are some substantial differences in risk estimation and treatment strategies among patients without known cardiovascular disease. This short review is focused on these differences and practical treatment approach to these patients based on present European and United States recommendations.


Herz | 2009

Stenting and Surgery for Coronary Vasospasm

Milan Nedeljkovic; Miodrag Ostojic; Nebojsa Lalic; Branko Beleslin; Ivana Nedeljkovic; Katarina Lalic; Miljko Ristic; Vojislav Giga; Lazar Angelkov; Miloje Tomasevic; Vladimir Kanjuh

A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.ZusammenfassungEin 55-jähriger Patient mit therapeutisch unkontrollierbaren koronaren Vasospasmen wurde 6 Monate nach Implantation der linken A. mammaria interna zur Abklärung von Brustschmerzen vorstellig. We - gen der wiederholten vasospastischen Anfälle und Komplikationen mit Kammerflimmern und Myokardinfarkt war zuvor ein Stent in die proximale LAD implantiert worden mit nachfolgender In-Stent- Restenose, nachdem angiographisch und mittels Ergonovintest schwere Koronarspasmen festgestellt worden waren.


Herz | 2009

Stenting and surgery for coronary vasospasm : the wrong solution fails to solve the problem.

Milan Nedeljkovic; Miodrag Ostojic; Nebojsa Lalic; Branko Beleslin; Ivana Nedeljkovic; Katarina Lalic; Miljko Ristic; Giga; Lazar Angelkov; Miloje Tomasevic; Kanjuh

A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.ZusammenfassungEin 55-jähriger Patient mit therapeutisch unkontrollierbaren koronaren Vasospasmen wurde 6 Monate nach Implantation der linken A. mammaria interna zur Abklärung von Brustschmerzen vorstellig. We - gen der wiederholten vasospastischen Anfälle und Komplikationen mit Kammerflimmern und Myokardinfarkt war zuvor ein Stent in die proximale LAD implantiert worden mit nachfolgender In-Stent- Restenose, nachdem angiographisch und mittels Ergonovintest schwere Koronarspasmen festgestellt worden waren.


Herz | 2009

Stenting and Surgery for Coronary Vasospasm@@@Stenting und Chirurgie bei Koronarspasmus. Mit der falschen Wahl misslingt die Lösung des Problems: The Wrong Solution Fails to Solve the Problem

Milan Nedeljkovic; Miodrag Ostojic; Nebojsa Lalic; Branko Beleslin; Ivana Nedeljkovic; Katarina Lalic; Miljko Ristic; Vojislav Giga; Lazar Angelkov; Miloje Tomasevic; Vladimir Kanjuh

A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.ZusammenfassungEin 55-jähriger Patient mit therapeutisch unkontrollierbaren koronaren Vasospasmen wurde 6 Monate nach Implantation der linken A. mammaria interna zur Abklärung von Brustschmerzen vorstellig. We - gen der wiederholten vasospastischen Anfälle und Komplikationen mit Kammerflimmern und Myokardinfarkt war zuvor ein Stent in die proximale LAD implantiert worden mit nachfolgender In-Stent- Restenose, nachdem angiographisch und mittels Ergonovintest schwere Koronarspasmen festgestellt worden waren.


International Journal of Cardiovascular Imaging | 2013

Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Voin Brkovic; Milan Dobric; Branko Beleslin; Vojislav Giga; Vladan Vukcevic; Sinisa Stojkovic; Goran Stankovic; Milan Nedeljkovic; Dejan Orlic; Miloje Tomasevic; Jelena Stepanovic; Miodrag Ostojic

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