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Background/Aim. The prognostic impact of complete atrioventricular (AV) block on the long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) has not been fully determined. The aim of the study was to analyze the incidence and prognostic impact of complete AV block on in-hospital mortality (IHM) and 6-year mortality in STEMI patients treated with primary percutaneous coronary intervention. Methods. The study included 3,044 consecutive STEMI patients. Results. Complete AV block was registered only on admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. A temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient under-went permanent pacemaker implantation. IHM was significantly higher in patients with complete AV block than in patients without complete A V b lock: 1 7.9% v s. 3 .6%, respectively, p < 0.001. In patients with heart block and inferior infarction, IHM was 13%, whereas IHM was 53% in patients with heart block and anterior infarction. When we analyzed patients discharged alive from the hospital, we also found a significantly higher long-term (6-year) mortality rate in those with complete AV block vs. patients without AV block: 7.8% vs. 3.4%, respectively, p < 0.001. Complete AV block was an independent predictor for IHM and 6-year mortality: IHM [odds ratio (OR) 2.94 95%, confidence interval (CI) 1.23?5.22; 6-year mortality hazard ratio (HR) 1.61, 95%, CI 1.10?2.37]. When subanalysis was performed in patients with inferior STEMI, complete AV block was an independent predictor of IHM and 6 -year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of IHM. Conclusion. In analyzed STEMI patients, complete AV block was transitory and was registered only on hospital admission. Although transitory, complete AV block remained a strong independent predictor of IHM and long-term mortality.

Background/Aim.The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748-0.761)] were age (≥ 65 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to adjust the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus. Uvod/Cilj. Preporuke za lečenje bolesnika sa akutnim infarktom miokarda sa elevacijom ST segmenta (STEMI), nalažu da se kod bolesnika koji ne mogu blagovremeno da odu na primarnu perkutanu intervenciju (p-PCI) primeni farmakoinvazivna (FI) strategija lečenja. Cilj rada bio je da se utvrde karakteristike bolesnika koji se uopšte ne leče reperfuzionom terapijom (RT), kao i da se analizira ishod lečenja pomoću RT, u zemlji u tranziciji u kojoj mreža za primenu FI terapije nije u potpunosti razvijena. Metode. Za istraživanje su korišćeni podaci bolničkog Nacionalnog registra za akutni koronarni sindrom Srbije (HORACS). Rezultati. Značajni prediktori za izostanak primene RT su prikazani u modelu (c 75,6%, SE0,004, 95% CI 0,748–0,761) u koji su uključene godine starosti (≥ 65), srčana insuficijencija (Killip klasa II-IV), dijabetes melitus, i vreme do prvog medicinskog kontakta (PMK) (> 360min). Kod bolesnika koji nisu bili lečeni RT, mortalitet je bio 15,7%, kod bolesnika lečenih fibrinolitičkom terapijom (FT) iznosio je 10,5%, a kod bolesnika lečenih p-PCI 6,2% ( p

Introduction/Objective. The purpose of the Echocardiographic Society of Serbia (ECHOS) national survey was to assess current echocardiography practice in Serbia, the availability of different echocardiographic techniques and self-perceived need for improvement at personal and institutional level. Methods. A survey comprising 20 questions about demographics, numbers and distribution of echocardiographic equipment and techniques, image acquisition and reporting standards as well as future educational preferences was sent to all ECHOS members via email. Results. A total of 106 members (42%) answered the survey. Echocardiographic examinations are most frequently performed by cardiologists and internal medicine specialists. Transesophageal echocardiography (TOE), stress echocardiography (SECHO) and speckle tracking echocardiography (SpTE) are available in approximately 20% of centers, three-dimensional echocardiography in 11%, while contrast echocardiography is practiced in only two centers. Less than a third of respondents always attach electrocardiographic electrodes and archive examinations. Almost all respondents (96%), always evaluate both systolic and diastolic function of the left ventricle (LV), although systolic LV function is frequently assessed (55%) using non-standard methods. The newer echocardiographic machines are more often available at university than non-university centers (87 versus 44%, p < 0.01). SECHO was perceived as the most needed technique at the institutional level, while SpTE and TOE were most often reported personal aspirations of the respondents. Conclusion. Advanced techniques, SECHO and TOE are needed but rarely performed outside the university hospitals in Serbia. In order to achieve a better adherence to standards of practice in echocardiography, the development of national guidelines and personal and laboratory accreditation seem warranted.

Background/Aim. The coincidence of left ventricular systolic dysfunction (LVSD) and renal dysfunction (RD) is a strong independent predictor of adverse events in the short-term and mid-term follow-ups of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The aim of this study was primarily to assess the prognostic impact of the LVSD-RD combination on the 5-year all-cause mortality in patients with STEMI treated with pPCI, as well as to assess the prognostic impact of the LVSD-RD combination on the occurrence of major adverse cardiovascular events (MACEs: cardiovascular death, reinfarction, stroke and target vessel revascularization) in these patients. Methods. We analyzed 951 patients divided into 4 groups according to the presence of LVSD (ejection fraction < 40%) and/or baseline RD (creatinine clearance < 60 mL/min): group I (no LVSD, no RD); group II (LVSD, no RD); group III (RD, no LVSD); group IV (LVSD+RD). Results. The 5-year mortality rates were 2.3%, 17.6%, 11.7% and 38.3%, while the 5-year MACE rates were 8.8%, 28.4%, 18.3% and 44.4% in the groups I, II, III and IV, respectively (p < 0.001). The highest percentage of lethal outcomes and MACE was registered in the first year of follow-up in all the groups. The 1-year landmark analysis confirmed that the patients with LVSD-RD combination had the highest percentage of lethal outcomes in the period of 1 to 5 years (p = 0.028). There was a strong trend toward the significance in the occurrence of MACE among the analyzed groups in the period of 1 to 5 years (p = 0.085). In the Cox regression model the LVSD-RD combination was a strong independent predictor of 5-year mortality and the occurrence of MACE: mortality hazard ratio (HR) 4.5 (95%CI 1.9-10.8); MACE HR 2.5 (95%CI 1.4-4.5). Conclusion. The strong negative independent prognostic impact of the LVSD-RD combination persisted in the long-term follow-up of the patients with STEMI treated with pPCI.