Zdravko Babić

Impact of admission anemia, C-reactive protein and mean platelet volume on short term mortality in patients with acute ST-elevation myocardial infarction treated with primary angioplasty.

OBJECTIVES To investigate admission anemia, C-reactive protein (CRP) and mean platelet volume (MPV) together as prognostic markers in ST-elevation myocardial infarction (STEMI). DESIGN AND METHODS Baseline hemoglobin, CRP and MPV were determined in 543 patients with acute STEMI to whom primary angioplasty was performed and evaluated for short term mortality (30 days). RESULTS After multivariate analysis anemia (odds ratio 2.69, 95% confidence interval 1.24-5.86) and CRP (odds ratio 3.40, 95% confidence interval 1.13-10.22) remained significant independent predictors of short-term mortality. Addition of anemia and CRP to PAMI risk score improved prediction of short-term outcome; area under ROC curve rose from 0.76 to 0.87 (p<0.001). CONCLUSION Better ability to determine 30-day mortality was obtained when anemia and CRP were incorporated into the PAMI risk score.

Successful primary percutaneous coronary intervention in the first trimester of pregnancy

A 28‐year‐old patient, medical nurse, in 10th week of her second pregnancy suffered ventricular fibrillation just after entering the waiting room of the emergency department. After she was successfully defibrillated, electrocardiography revealed a large acute anteroseptolateral ST elevation myocardial infarction. Urgent coronarography was done (premedication with 300 mg of aspirin and 600 mg of clopidogrel) with 90 min door‐to‐balloon time. Proximal left anterior descending occlusion was found, primary percutaneous coronary intervention was done using Amazonia CroCo 3.0/12 bare‐metal stent, and Thrombolysis in Myocardial Infarction III flow was achieved. During the procedure, the patient was wrapped in lead apron. Because of postresuscitational agitation, procedure was done in intravenous anesthesia. The revealed risk factors were smoking and hypercholesterolemia. PAI‐1 gene 4G/4G genotype and Apo E gene E2/E4 genotype were also found. Estimated X‐ray dosage that fetus received during the procedure was 0.45 mSv, which is less than the upper safe limit in pregnancy. All drugs given to our patient (clopidogrel, aspirin, ivabradine, bisoprolol, anesthetics, low‐molecular‐weight heparin, and unfractionated heparin) have B or C Food and Drug Administration Pregnancy Category. Fetal ultrasonography showed normal fetal growth, and, after consultation with our team, the patient decided to maintain the pregnancy. Before discharge echocardiography showed left ventricle of normal size with anteroseptolateral hypokinesia, small apical aneurysm, left ventricular ejection fraction of 40–45%, and diastolic dysfunction grade II, without pulmonary hypertension. At the 36th week of pregnancy, the patient was hospitalized and closely monitored; clopidogrel and aspirin were discontinued, and low‐molecular‐weight heparin was administered. She gave birth to a normal boy by vaginal delivery with epidural anesthesia and without any complication.

Metabolic syndrome: infl uence on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

Objective The aim of this study was to investigate the metabolic syndrome (MS) infl uence on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods We prospectively analysed 250 patients with acute STEMI treated with primary PCI, between September 2011-2012. MS was diagnosed by the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients were divided into two groups (with/without MS) and compared by their baseline data (medical history, demographic and anthropometric data) and parameters of severity (clinical, laboratory, echocardiography, coronary angiography and in-hospital complications data) and prognosis (major adverse cardiovascular events and sick leave duration (SLD) during 12 months of follow-up). Results Our study included 136 (54.4%) and 114 (45.6%) patients with and without MS, respectively. MS patients had longer hospitalization (9.0 vs 8.0 days), higher rates of total in-hospital complications (25.0% vs14.9%), higher number of signifi cantly stenosed coronary arteries (CAs) (2 vs1), higher stent diameters (3.5 vs3.0 mm) ,higher rate of signifi cantly stenosed proximal and middle CAs segments (94.1% vs86.7%), and longer SLD (16 vs10 weeks) (P <0.05). MS was independently associated with higher risk of total in-hospital complications (odds ratio (OR) 1.90, confi dence interval (CI) [1.06-3.64], P= 0.047) and with higher risk of ? 2 signifi cant stenosed CAs (OR 1.72, CI [1.04-2.84], P= 0.034). Conclusion MS in acute STEMI is an important predictor of total in-hospital complications and severity of CAs disease, but not for other parameters of severity and prognosis. MS patients have longer SLD.

The importance of two metabolic syndrome diagnostic criteria and body fat distribution in predicting clinical severity and prognosis of acute myocardial infarction

Introduction The interrelation between metabolic syndrome (MetS) (the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF)) and obesity indices in predicting clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI) is insufficiently known. Material and methods This prospective study included 250 acute STEMI patients treated with primary percutaneous coronary intervention. The patients with/without MetS were analyzed by baseline (medical history, demography and obesity indices: overall – body mass index (BMI) vs.central – body adiposity index (BAI), conicity index (Cindex), visceral adiposity index (VAI), waist circumference (WC), waist-to-hip (WHR) and waist-to-height ratio (WHtR)), severity (clinical presentation, laboratory, echocardiography, coronary angiography and in-hospital complications) and prognostic parameters (major adverse cardiovascular events and sick leave duration during 12-month follow-up). Results There were 136 (54.4%) and 147 (58.8%) patients with MetS (NCEP-ATP III) and MetS (IDF), respectively. MetS (NCEP-ATP III) increased the risk of > 1 significantly stenosed coronary artery (CA), very high BAI increased the risk of dyspnea, Cindex > 1.25/1.18 increased the risk of total in-hospital complications, increased VAI increased the risk of coronary segment 3 significant stenosis, WHR ≥ 0.90/0.85 increased the risk of proximal/middle coronary segments (especially of segment 1) significant stenosis, WHtR ≥ 63/58 increased the risk of heart failure, and the number of significantly stenosed CAs increased the risk of total MACE (p < 0.05). Conclusions MetS (NCEP-ATP III) and several central obesity indices are superior to BMI in predicting acute STEMI severity (clinical presentation, in-hospital complications, severity of coronary disease), while WC and MetS (IDF) have no influence on it. They all have no influence on prognosis.

Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era

OBJECTIVES To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. MATERIAL AND METHODS During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days). RESULTS Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. CONCLUSIONS Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease.

Electrophysiological predictors of propafenone efficacy in prevention of atrioventricular nodal re-entrant and atrioventricular re-entrant tachycardia

Aim To assess the efficacy of propafenone in prevention of atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT) based on the clinical results of arrhythmia recurrence and find the electrophysiological predictor of propafenone effectiveness. Methods This retrospective study included 44 participants in a 12-month period, who were divided in two groups: group A – in which propafenone caused complete ventriculo-atrial block and group B – in which propafenone did not cause complete ventriculo-atrial block. Results Group A had significantly lower incidence of tachycardia than group B (95% vs 70.8%, P = 0.038), and complete ventriculo-atrial block predicted the efficacy of propafenone oral therapy in the prevention of tachycardia (sensitivity 87.5%, specificity 52.8%, positive predictive value 95%, negative predictive value 29.2%). Patients with AVNRT in group B who did not experience the recurrences of tachycardia had significantly shorter echo zone before intravenous administration of propafenone than the patients who experienced episodes of sustained tachycardia (median 40 ms [range 15-60 ms] vs 79 ms [range 50-180 ms], P = 0.008). Conclusion In patients with non-inducible tachycardia, complete ventriculo-atrial block can be used as an electrophysiological predictor of the efficacy of propafenone oral therapy in the prevention of tachycardia. In patients with non-inducible AVNRT, but without complete ventriculo-atrial block, propafenone was more effective in patients with shorter echo zone of tachycardia.

Plasminogen activator inhibitor-1 activity and long-term outcome in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: a prospective cohort study

Aim To determine the relationship between plasminogen activator inhibitor-1 (PAI-1) activity rise during the first 24 hours of ST-elevation myocardial infarction (STEMI) treatment and death after 5 years. Methods From May 1, 2009 to March 23, 2010, 87 STEMI patients treated with primary percutaneous coronary intervention (PCI) at the Sestre Milosrdnice University Hospital Center were consecutively enrolled in prospective single-center cohort study. PAI-1 activity was determined on admission and 24 hours later. The primary end-point was death after 5 years. The predictive value of PAI-1 activity variables as biomarkers of death was assessed using receiver operating characteristic (ROC) curve, independent predictors of death were assessed using multivariate Cox regression, and covariates independently related to higher PAI-1 activity rise were assessed using linear regression. Results Two patients died during the hospital treatment and 11 during the follow-up. PAI-1 activity rise had the largest area under curve (0.748) for predicting death rate (optimal cut-off point 3.7 U/mL, sensitivity 53.8%, specificity 90.5%). Patients with PAI-1 activity rise higher than 3.7 U/mL had significantly higher mortality (P < 0.001). Kaplan-Meier survival curve diverged within the first year after STEMI. Independent predictors of death were PAI-1 rise and final TIMI flow. PAI-1 activity rise was independently related to heart failure, thrombus aspiration, and body weight. Conclusion PAI-1 activity rise higher than 3.7 U/mL is associated with higher 5-year death rate in STEMI patients treated with primary PCI. Oxford Centre for Evidence-based Medicine level of evidence: 3.

Pancreatitis and the broken heart

2018;13(1-2):28. Background: Broken heart syndrome or Takotsubo syndrome (TTS) is considered a type of acute and usually reversible heart failure episode, often indistinguishable from acute coronary syndromes, characterized by the lack of significant obstructive coronary artery disease. The most characteristic wall motion pattern is apical ballooning. Reversible LV dysfunction affects more than one coronary territory and timelines of recovery is variable. It is believed that enhanced sympathetic stimulation induces transient myocardial stunning through a variety of mechanisms associated with emotional or physical stress. To the best of our knowledge, there is only one published case report of TTS resulting from the exacerbation of chronic pancreatitis1. Case report: We report the case of a 69-year-old lady with fouryear history of chronic pancreatitis who came to our emergency room with acute epigastric pain and vomiting associated with STelevation in precordial leads (Figure 1) and elevated troponin (troponin I 1496 ng/L). Moreover, serum amylase (315 U/L) and lipase (249 U/L) were increased. Echocardiography revealed a dilated and hypokinetic apex with reduced left ventricle ejection fraction (LVEF 40%). The abdominal ultrasound showed inhomogeneous pancreas with calcifications. Obstructive lesions of coronary arteries were absent on the angiogram and apical ballooning was demonstrated on left ventriculography (Figure 2).The findings were consistent with TTS and acute exacerbation of chronic pancreatitis. The patient was managed with intravenous crystaloids, analgesics, anti-emetics, beta blockers, ACE inhibitors. Over the next 2-3 days she was able to tolerate an oral diet. The ECG typiPetra Grubić Rotkvić1*, Jozica Šikić1,2, Jasna Čerkez Habek1,3, Dean Strinić1, Zdravko Babić4, Marin Pavlov4

Spontaneous pneuomopericardium: an unusual complication of abdominal carcinoma.

2016;11(3-4):140. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloskih medicinskih sestara i tehnicara Pneumopericardium is a rare condition defined as a collection of air in the pericardial cavity. It is usually caused by blunt or penetrating chest injuries, iatrogenic causes (bone marrow puncture, thoracic surgery, pericardiocentesis, endoscopic procedures), and infectious pericarditis with gas-producing organisms.1,2

The influence of air pollutants on appearance of acute myocardial infarction in the region with humid continental climate.

The paper analyzes the influence of air pollutants on the incidence of acute heart failure in the city of Zagreb.