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During the past 10 years, the health of people in Eastern Europe and the former Soviet Union has undergone changes very different from the health patterns seen in their Western counterparts. Mortality from cardiovascular disease has been decreasing continuously in the USA and many Western European countries, but it has increased or remained unchanged in many of the states of Eastern Europe. Analysis of this phenomenon has been hindered by insufficient information. The International Registry of Acute Coronary Syndromes registry study in Transitional Countries (ISACS-TC) is both a retrospective - over a 1-year period - and prospective study which was designed in order to obtain data of patients with acute coronary syndromes (ACSs) in countries with economy in transition in Central and Eastern Europe, and herewith control and optimize internationally guideline recommended therapies in these countries. Adhesion to the project was given by 112 Collaborating Centres in 17 countries with economy in transition (Albania, Bosnia and Herzegovina, Belarius, Bulgaria, Croatia, Hungary, Kosovo, Latvia, Lithuania, Macedonia, Moldova, Montenegro, Romania, Russian Federation, Serbia, Slovakia, Slovenia, and Ukraine). A total of 47 cluster sites in 11 countries in Central and Eastern Europe are currently collaborating in ISACS-TC. The registry encourages optimal individualization of evidence-based therapies and the international patient body ensures good representation of multiple practice patterns. It may help to make an additional improvement in clinical outcomes of countries with economy in transition.

We sought to investigate characteristics, treatment, and outcome of octogenarian patients during hospital stay for acute coronary syndrome (ACS) in a transitional country. This is a cohort study of 437 patients ≥ 80 years old, consecutively admitted with a diagnosis of ACS at 14 hospitals in 8 Eastern European countries reporting data to ISACS-TC registry. The primary endpoint was in-hospital mortality. The mean age of the study population was 83.5 years ; 50.1% of the patients were women. Females, less frequently than males, had a history of myocardial infarction, smoking habit, and episodes of typical chest pain. But they were more often admitted with left ventricular dysfunction. The rate of reperfusion treatment (29.5%) was very low in patients with ST-elevation myocardial infarction (STEMI). Also, most of the overall study population had a non-invasive approach (women, 79% vs. men, 70.6% ; P = 0.042). However, when the coronary anatomy was known, there were no differences in the rates of revascularization between genders. There was no difference in the rates of death between male (21%) and female (21.1%) patients. Univariate and multivariate analyses revealed that the independent predictors (P < 0.05) of death in octogenarians were systolic blood pressure

It is essential that context-appropriate health research and health interventions take place in countries with economy in transition. The aims of this study were to describe the clinical characteristics, management, and in-hospital outcomes of acute coronary syndrome (ACS) patients with heart failure (HF) in Montenegro and Serbia. The data of this study are a framework of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; [NCT01218776][1]), a multi-national and multicentre registry of patients hospitalized with ACS in the European countries that emerged from the Socialist era. The present analysis focused on participants admitted to 15 hospitals in Montenegro and Serbia with a diagnosis of ACS during the period between October 2012 and August 2013. Among 1115 patients, 94 (8.4%) had an admission diagnosis of HF (Killip Class II or III). Heart failure patients were significantly older ( P < 0.001). Heart failure was more frequently associated with hypertension. When compared with patients presenting without HF (Killip Class I), those with HF had lower rates of reperfusion therapy either by percutaneous coronary intervention (47.9 vs. 60.7%, P = 0.015) or by fibrinolysis (2.1 vs. 11.8%, P = 0.004). In multivariate logistic regression analysis, older age, prior coronary artery bypass graft, and ST-segment elevation myocardial infarction were the relevant predictor of HF at admission. Heart failure on admission was associated with a marked increase in mortality rates during hospitalization (13.8 vs. 3.7%, P < 0.001). After adjustment for differences in clinical characteristics, HF was still associated with higher mortality (odds ratio 2.88, 95% confidence interval 1.22–6.79, P = 0.016). Heart failure is observed in nearly 9% of patients with ACS in Serbia and Montenegro and is also associated with a significant increase in in-hospital mortality. More aggressive treatment of these patients is warranted to improve prognosis. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01218776&atom=%2Fehjsupp%2F16%2Fsuppl_A%2FA61.atom

Background: No-reflow occurring during percutaneus coronary intervention (PCI) has been associated with poor in-hospital outcomes. Purpose: The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline preprocedural treatment options may affect clinical outcomes. Methods: Data were derived from the International Survey of Acute Coronary Syndromes in Transitional Countries (NCT01218776) registry, a prospective survey of patients presenting with ACS over a 5-year period (January 2010 to January 2015). We prospectively collected data from 5997 patients undergoing PCI, identifying those with no-reflow, and analyzed their treatments and clinical outcomes. No-reflow was defined as post-PCI TIMI flow grade 0–1, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality. Results: No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (≥75 years; OR: 2.78; 95% CI: 1.15–6.71) and to have ST-elevation myocardial infarction (OR: 3.67; 95% CI: 1.57–8.56). No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%, P

Background: Limited data are available in octogenarian patients, and most of these studies excluded older patients with significant co morbid conditions. This is an observational study of octogenarians admitted for acute coronary syndrome (ACS). Purpose: We sought to investigate clinical characteristics, treatment and outcome of octogenarian patients during hospital stay for ACS in transitional country. Methods: Data were collected in the ISACS-TC registry (ClinicalTrials.gov,NCT01218776) from October 2010 to February 2015: there were 992 patients ≥80 years old, consecutive admitted with a diagnosis of ACS at 58 hospitals in 11 Eastern European countries. Patients who had undergone fibrinolysis and coronary artery bypass grafting (CABG), were also excluded. In-hospital mortality was the primary end-point. Results: Octogenarian patients represent 7.5% of ISACS-CT population. Among these, 56.7% were admitted with a diagnosis of ST segment elevation myocardial infarction (STEMI). The mean age of the study population was 83.5±3.5 years and 51.6% of the patients were women. Female, less frequently than male, had history of myocardial infarction, peripheral artery disease (PAD), prior CABG and chronic kidney disease. They were less likely to have smoking and former smoking status. There was no difference in the rates of death between male (18.5%) and female (19.2%) patients. Octogenarian patients undergoing invasive coronary procedures had significantly lower rate of death (12.5% vs 22.2 P