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Aim: To assess whether the number of patients with a cardiac chief complaint and their characteristics differed between before and after two major earthquakes that struck Croatia in 2020., Methods: We collected data on all visits of patients with a cardiac chief complaint examined in the emergency departments of six hospitals nearest to the epicenters. Patients seen during the 7 days before the earthquake were compared with those seen on the day and during the 6 days after the earthquake., Results: Patients seen after the earthquake were younger (68 [59-79] vs 72.5 [65-80]; P<0.001) and less frequently had cardiovascular disease (32.9% vs 42.8%; P<0.001). This group less frequently had the primary diagnosis of acute myocardial infarction (AMI) (15.6% vs 21.9%; P=0.005), heart failure (9.3% vs 19.4%; P<0.001), dysregulated hypertension (13.9% vs 19.4%; P=0.01), but more frequently had non-anginal chest discomfort (28.8% vs 18.0%; P<0.001). In a subgroup analysis of patients seen in hospitals located within 20 km from the epicenter, significantly more patients seen after the earthquake compared with those seen before the earthquake presented with AMI (14.5% vs 22.8%; P=0.028), acute elevation of blood pressure (10% vs 21.8%, P=0.001), and paroxysmal arrhythmias treated with electrocardioversion (0.9% vs 4.5%, P=0.022)., Conclusion: After two moderately strong earthquakes, hospitals within 20 km from the epicenter saw a significant increase in acute cardiac conditions such as elevated blood pressure, AMI, and cardioverted arrhythmias. Eventually, these earthquakes had no impact on the outcomes of the studied population.

Background: The aim of this study was to define the level of patient exposure to stress in the previous 5 years before acute myocardial infarction (AMI), personality type A assessment, ways of coping with stressful situations, health locus of control and the grade of anxiety (as state and personality trait)., Subjects and Methods: 118 patients who were consecutively hospitalized during 8 months in our Coronary care unit due to AMI, took part in the study. As controls we examined 103 healthy male volunteers (mean age 60.8±2.93 years)., Results: AMI patients presented with higher degree of behavior corresponding to type A personality (F=18.756, p=0.000), and also showed higher degree of anxiety, as state and personality trait (F=23.634, p=0.001; F=19.253, p=0.000), in comparison to healthy controls. Also, AMI patients were significantly more often coping emotionally in stressful situations than control subjects (F=21.354, p=0.000), and they had significantly higher external locus of control compared to healthy subjects (F=13.284, p=0.001). They often considered that they were not able to control their health, namely they evaluated their ability to control their health as weak and were much more often directed to cope with intense emotions (r=0.24, p=0.002)., Conclusions: The study showed that AMI patients psychologically differed from the healthy controls, indicating that they were prone to maladaptive behavioral patterns which could favor development and complicate course of coronary artery disease.

Background: The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline pre-procedural treatment options may affect clinical outcomes., Methods: Data were derived from the ISACS-TC registry (NCT01218776) from October 2010 to January 2015. No-reflow was defined as post-PCI TIMI flow grades 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 (OR: 1.20, 95% CI: 1.01-1.44), to have a history of hypercholesterolemia (OR: 1.95, 95% CI: 1.31-2.91) and to be admitted with a diagnosis of STEMI (OR: 2.96, 95% CI: 1.85-4.72). Angiographic characteristics associated with no-reflow phenomenon were: stenosis ≥50% of the right coronary artery, presence of multivessel disease and pre-procedural TIMI blood flow grades 0-1. No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%; adjusted OR: 4.60, 95% CI: 2.61-8.09). Administration of pre-procedural unfractioned heparin or 600mg clopidogrel loading dose was associated with less incidence of no-reflow (OR: 0.65, 95% CI: 0.43-0.99 and 0.61, 95% CI: 0.37-1.00, respectively). Aspirin, enoxaparin, and 300mg clopidogrel loading dose, did not significantly impact the occurrence of the no-reflow., Conclusions: We found that pre-procedural administration of 600mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The authors investigated trends in the Croatian primary Percutaneous Coronary Intervention (pPCI) Network results among three consecutive time intervals (2005-2007, first phase; 2008-2009, second phase; and 2010-2011, third phase). Data on 5650 patients with acute myocardial infarction with ST-elevation (STEMI) transferred or directly admitted and treated with pPCI in 11 Croatian PCI centers during the study period were collected and analyzed. The number of patients with acute STEMI treated with pPCI per year rose continuously during the study period (581 vs. 1272 vs. 1949 patients/year). The patient risk profile worsened during the study period: age (60 vs. 61 vs. 63 years; p<0.01), anterior myocardial wall involvement (43% vs. 44% vs. 51%; p<0.01), shock rate (7% vs. 9% vs. 11%; p<0.05), and percentage of transferred patients (42% vs. 36% vs. 46%; p<0.01). While the door-to-balloon time shortened (108 vs. 98 vs. 75 min; p<0.01), the symptom onset-to-door time increased (130 vs. 175 vs. 195 min; p<0.01), but without statistically significant influence on the total ischemic time. Multivariate log-linear analysis eliminated influence of a higher risk profile on the results of treatment and yielded no statistically significant changes in final TIMI 3 flow (Thrombolysis In Myocardial Infarction 3), in-hospital mortality, and six-month mortality rate, but revealed a significant increase in the rate of angina pectoris (12 vs. 22 vs. 36%; p<0.01) and other major adverse cardiovascular events (MACE; 6 vs. 23 vs. 14%; p<0.01) during follow up. In conclusion, the Croatian pPCI Network continuously ensures very good results of STEMI treatment in this economically less developed European country despite worsening of the risk profile in treated patients and opening of new, less experienced PCI centers. The higher percentage of MACE over time could be explained by changes in the pPCI strategy introduced over time (the culprit lesion only) and higher availability of PCI centers for additional PCI after acute STEMI. However, there is room for improvement, especially in reducing prehospital delay.

Objective: We sought explore the relative benefits of unfractionated heparin (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in ST-segment elevation myocardial infarction (STEMI) patients not undergoing reperfusion therapy., Methods: This is a propensity score study from The International Survey on Acute Coronary Syndromes in Transition Countries (ISACS-TC/NCT01218776) on patients admitted between October 2010-June 2013. There were a total of 1175 STEMI patients who did not receive mechanical or pharmacological reperfusion. Of these, 1063 were eligible for the aim of the study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) patients. The primary endpoint was in-hospital mortality. Secondary endpoints were intracranial hemorrhages, and clinically relevant bleedings., Results: After adjustment for any confounders, UFH was associated with a lower risk of in-hospital mortality in clopidogrel users (multivariate adjusted regression analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41-0.94) as compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55-1.60). The observed effect was not associated with combined enoxaparin and clopidogrel therapy. Major bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 1.5% respectively, p = 0.06). The risk of major hemorrhage was nearly similar with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), p = 0.67., Conclusion: UFH - Clopidogrel combination was associated with a large mortality reduction in STEMI patients not undergoing reperfusion therapy and did not significantly increase the risk of major bleeding., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, with available data showing similar outcomes in both chronic kidney disease (CKD) and non-CKD patients1. The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without CKD receiving DCB PCI. Patients and Methods: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2023 (n=652). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. Chronic kidney disease was defined as estimated glomerular filtration rate < 45 ml/ min/1.73m2. A FUP angiography was performed in 49% of patients (n=317), with a median FUP of 6 (interquartile range 3 - 18) months, without difference between groups. Results: Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. CKD was present in 9% (n=57) of patients and was associated with a higher incidence of arterial hypertension, diabetes mellitus, atrial fibrillation, as well as peripheral artery disease. The age difference was noted between groups, with CKD patients being older on average. At initial PCI, more CKD patients had multivessel coronary disease, with a higher rate of ISR as the indication for DCB, that was not statistically significant (CKD vs non-CKD: 46% vs 34%, p=0.075). After DCB, no difference was noted between groups in regards to the need for a bail-out PCI (9% VS 6%, P=0.375). FUP was performed in an equal percentage of patients in both groups (48% vs 51%, p=0.769), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.998), the need for target lesion PCI (17% vs. 13%, p=0.533), or the use of anti-anginal drugs. Conclusion: The findings of our single-centre analysis show that patients with CKD do not have a higher risk of target lesion restenosis after DCB PCI, when compared to the non-CKD group, which is in accordance with currently available evidence2. [ABSTRACT FROM AUTHOR]

Introduction: Acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UA), has been less researched in the subpopulation of young patients. Sex differences in discharge therapy after ACS have been described in older patients as favouring the male sex, and we decided to test this hypothesis in young patients. The term “young” (with regard to ACS) is not uniquely defined, but according to multiple sources, the proposed cut-off age is 45 years. Patients and Methods: A total of 361 young patients (with an age cut-off of 45 years for men and 55 years for women) with ACS and percutaneous coronary intervention (PCI) performed at the University Hospital Centre Zagreb (UHCZG) between Jan 1st 2012 and Jan 1st 2020 were enrolled. The patients were divided into the UHCZG group (241 patients discharged home after ACS) and the PCI network group (120 patients transferred to another medical facility after ACS). We explored statistically relevant associations between sex and discharge therapy using the Pearson chi-square test in the UHCZG group, due to the completeness of this dataset. Results: The mean patient age in the UHCZG group was 44±7 years, and 148 (61.4%) were men. 139 (57.9%) patients had STEMI, 72 (30.0%) NSTEMI, and 29 (12.1%) had UA (Table 1, Figure 1). Female patients had a higher prevalence of hypothyroidism, lower diastolic blood pressure at admission and higher LDL values (Table 1). A significantly higher proportion of male patients were prescribed with angiotensin-converting enzyme inhibitors (ACEi) (82.4% versus 65.6%, p=0.003). There were no sex differences in the prescription of other cardiovascular drugs (Table 2). Conclusion: In a group of young patients with ACS, we found a statistically significant difference between male and female patients regarding the prescription of ACEi, despite a lack of significant difference in systolic blood pressure. Results similar to ours, regarding sex differences in optimal medical therapy, have been described in the literature, including young ACS patients.These results raise concerns regarding potentially negative consequences on the health of young women treated for ACS. [ABSTRACT FROM AUTHOR]

Background and Aim: There are still wide knowledge gaps in myocardial infarction with non-obstructive coronary arteries (MINOCA) - a heterogeneous entity seen in 1-10% of patients with acute coronary syndrome (ACS)1. The aim is to determine characteristics of MINOCA in the Croatian branch of the ISACS-CT registry, and compare them to age- and gender-matched patients with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Patients and Methods: The study included 2487 patients with ACS. MINOCA was defined by simultaneous cardiac troponin levels >0.014 ng/L, symptoms of ischemia or significant ST-T changes in the ECG, and an absence of coronary artery stenosis of ≥ 50% on angiography. Age and gender-matching was performed from the remaining cohort by randomly sampling patients from the UA, STEMI and NSTEMI subgroups, based on the mean age ± 5 years and the gender ratio of the MINOCA group. Results: MINOCA was seen in 2.5% (n=63) of the cohort, initially categorized as UA (37%), NSTEMI (48%) and STEMI (16%). Median age was 62 (53, 71) years, 56% male. After age- and gender-matching, there were 36 UA (10% of the UA cohort), 135 NSTEMI (15%) and 198 STEMI (16%) patients in the ACS control subgroups. MINOCA patients had a lower prevalence of diabetes, hypertension, dyslipidemia, chronic kidney disease and tobacco use as compared to UA and NSTEMI. MINOCA patients used less antiplatelets, beta-blockers and statins before hospitalization. MINOCA and STEMI subgroups had a high incidence of chest pain symptoms and a short time from symptom onset to hospitalization. In the first 24h of hospitalization, less MINOCA patients were treated with antiplatelets and statins, and at discharge, they were less frequently prescribed with antiplatelet drugs compared to UA and NSTEMI (Table 1). Inhospital mortality was low, with no deaths in MINOCA and UA patients, and 2 and 3 deaths in NSTEMI and STEMI, respectively. Conclusion: MINOCA patients are mainly categorized as UA and NSTEMI at presentation, but have less comorbidities, more pronounced symptoms of typical chest pain, a shorter time from symptoms to hospitalization, lower levels of statin and antiaggregation prescription at admission, and antiaggregation at discharge. In-hospital mortality confirms MINOCA as low risk, however, long-term registry follow-up is needed to learn about longer term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In 2020 Croatia was stuck with two major earthquakes: on March 22nd with epicenter 7 km north of Zagreb city centre and on 29th December with epicenter 5 km south of city of Petrinja (5.5 and 6.2 degrees on the Richter scale respectively). The authors sought to investigate whether these events had an influence on characteristics and number of patients with cardiac chief complaints examined in the Emergency Departments (ED)1,2. Patients and Methods: Data on all emergency visits of patients with cardiac chief complaint examined in two University Hospital Centres (UHC) (Sestre Milosrdnice UHC, Zagreb and Zagreb UHC, Zagreb), two University Hospitals (UH) (“Sveti Duh UH, Zagreb and “Merkur” UH, Zagreb) and two regional hospitals (Sisak General Hospital, Sisak and Karlovac General Hospital, Karlovac) examined 7 days prior to earthquake, on the day of each earthquake, and during subsequent 6 days were collected. Results: In the examined period, there were 5575 ED visits (average age 66 years, female gender 45%), out of which in 1251 (22.4%) cases the chief complaint was cardiac. While in all patients seen after the earthquake only more often primary cardiac diagnosis found was non-anginal chest discomfort (28.8% vs 18.0%; p<0.001), when narrowed down the patients group to only the ones who were located within the 20 kilometers from the epicenter we found that there was significantly more patients with acute myocardial infarction (14.5% vs 22.8%; p= 0.028), acute elevation of blood pressure (10% vs 21.8%, p= 0.001), as well as more paroxysmal arrhythmias treated with electrocardioversion (0.9% vs 4.5%, p=0.022) (Table 1). Conclusion: In this study, increment in the frequency of cardiac emergencies was detected after a moderate earthquake in patients who were within 20 kilometers of the epicenter. They had significantly more often acute myocardial infarction, acute elevation of blood pressure, as well as paroxysmal arrhythmias treated with electrocardioversion. The health system should be prepared to treat a larger number of cardiac patients in difficult conditions after the earthquake. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is related to higher rates of complications after coronary revascularization. ¹ The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, however data on outcomes in DM is scarce.² The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without DM receiving DCB PCI. Patients and Methods: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2022 (n=645). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. An FUP angiography was performed in 47% of patients (n=295), with a median FUP of 29 (interquartile range 8-41) months. Results: Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. DM was present in 35% (n=223) of patients, equally in both sexes, and was associated with a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke, as well as arterial hypertension, and renal insufficiency. No age difference was noted between groups. At initial PCI, more DM patients had multivessel coronary disease and ISR as the indication for DCB (DM vs non-DM: 41% vs 31%, p=0.023). After DCB, no group difference was noted in regard to the need for a bail-out PCI. FUP was performed in an equal percentage of patients in both groups (50% vs 45%, p=0.256), with no differences seen in the incidence of restenosis (18% vs. 17%, p=0.965), the need for target lesion PCI (15% vs. 12%, p=0.491), or the use of anti-anginal drugs. Conclusion: The findings of our single-centre analysis show that although DM is related to more advanced comorbidities it does not increase the risk of target lesion restenosis after DCB PCI. DCB PCI should be considered as a therapeutic option in candidate patients regardless of DM status. [ABSTRACT FROM AUTHOR]

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients during cardiac arrest and cardiogenic shock and is associated with increased survival rate. Since mortality on ECMO is still rather high, SAVE (Survival after Veno-Arterial ECMO) score can be used to predict survival from refractory cardiogenic shock requiring ECMO. Patients and Methods: We performed a retrospective analysis of 121 patients (78% male) who underwent VA-ECMO implantation in our Department from January 2011 till November 2020 (Figure 1 and Table 1). Results: Median age was 58 years with 21% of patients older then 65 years. Median of ECMO duration was 6 days. The most common causes of cardiogenic shock were acute myocardial infarction and cardiomyopathy (53% and 37%, respectively) (Figure 2), and 37% patients were implanted during cardiopulmonary resuscitation (eCPR). Overall survival on ECMO support was 59%, but in patients after CPR only 34%. Furthermore, of all patients, 34% were successfuly weaned and the rest who survived continued on advanced heart failure therapies (Figure 3), but overall survival in follow-up was only 26%. Median SAVE score was -8 with significantly less negative values in patients younger than 65 and treated after 2015. Also, patients treated before 2015 had significantly higher values of creatinine, free hemoglobine and international normalized ratio (INR) and their survival rate was only 39%, in comparison to those who were implanted after 2015 whose survival rate was 62%. [ABSTRACT FROM AUTHOR]

Background: A plethora of studies have proven the increase in cardiovascular risk associated with smoking in all age groups1, including the one at the focus of this study - the young2,3. With regard to the total number of coronary arteries (CA) with significant stenoses, one might expect current smokers to have more affected CA than non- and former smokers. Aim: To explore the relationship between smoking status and the total number of CA with significant stenoses in a young ST-segment elevation myocardial infarction (STEMI) population. Patients and Methods: Data were attained from medical records of 147 patients (mean age 43.9±6.5 years) hospitalized with STEMI at the University Hospital Centre Zagreb from January 2012 to October 2018, with a cut-off age at 45 years for men (n = 93) and 55 years for women (n = 54). Patients were divided in 2 groups based on smoking status - non- and former smokers (N = 29 (20%), with former smokers making up 9/29 or 31% of the group), and current smokers (N = 118 (80%)). To evaluate whether smoking status was associated with a higher total number of CA with significant stenoses, Pearson's chi-squared test was performed. During post hoc testing, the p value was adjusted to maintain the familywise error rate at 0.05 (p = 0.008) and compared to p values of each subgroup. Results: The two groups had no significant differences in baseline characteristics (Table 1). In both groups, the majority of patients (58.6% vs. 74.6%) had only one affected CA, followed by two (27.6% vs. 19.5%) and three (13.8% vs. 5.9%) CA. Pearson's chi-squared test showed no statistically significant difference in the total number of affected CA between the two groups (p = 0.176). Post hoc testing confirmed statistically insignificant associations in all subgroups (p > 0.008, Table 2). In multiple regression (F (2, 144) = 9.27, p < 0.001, R2 adjusted = 0.10), age (B = 0.03, p = 0.001) and family history for cardiovascular disease (B = 0.30, p = 0.003) remained associated with the number of affected CA. Conclusion: Within our dataset of young patients with STEMI, a very high proportion (reaching 80%) were active smokers. A similar total number of CA was affected by significant stenoses, regardless of smoking status. However, caution should be exercised when interpreting these results that require additional input on comorbidities and risk factors enabling conclusions to be drawn from a broader context. [ABSTRACT FROM AUTHOR]

Background and Aim: The relevance of dual antiplatelet therapy (DAPT) in acute ST-segment elevation myocardial infarction (STEMI) is well-established (aspirin and P2Y12 inhibitors).1 The role of glycoprotein (GP) IIb/IIIa inhibitors in clinical practice is not completely defined. Administration in the event of thrombotic complications is considered reasonable, although there is no evidence for routine use in primary percutaneous coronary intervention (pPCI). The aim was to analyze early outcomes of STEMI patients (pts) in the Croatian branch of the ISACS-CT (International Registry of Acute Coronary Syndromes in Transitional Countries) registry, depending on received antiaggregation therapy. Patients and Methods: Data were gathered retrospectively from pts hospitalized between January 2012 to October 2017. The study included 2503 pts with acute coronary syndrome, from which 48.9% (n=1224) were diagnosed with STEMI. The patients were divided into 4 groups depending on administered antiaggregation therapy. Results: For 7.8% (n=96) pts antiaggregation therapy data were missing, and 5.8% (n=71) were not treated with DAPT. Remaining 1057 (86.4%) pts were analyzed. Aspirin was administered in 95% of pts in the first 24 hours. 41.9% (n=443) of pts were additionally treated with clopidogrel, 16.1% (n=170) with ticagrelor, 28.6% (n=302) with clopidogrel and eptifibatide, and 13.4% (n=142) with ticagrelor and eptifibatide (Table 1). The groups did not differ in comorbidities, while pts receiving eptifibatide had lower systolic blood pressure on admission. Patients treated with eptifibatide were more frequently male, smokers, of younger age, had more thrombotic complications seen on coronary angiography (predominantly distal embolisation and "no-reflow" phenomenon) and lower in-hospital mortality. In a multivariable regression model adjusted for age, gender, hypertension, diabetes, and pPCI, increasing age (OR=1.1), diabetes (OR=1.9) and pPCI (OR=0.5) remained relevant to in-hospital mortality. Conclusion: STEMI patients that are young, male and smokers are more frequently treated with eptifibatide, likely due to a higher burden of thrombotic complications. Unlike the choice of antiaggregation therapy, increasing age, diabetes and non-invasive management of STEMI were associated with in-hospital mortality. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

His bundle pacing activates the ventricles physiologically by direct stimulation of the His-Purkinje cardiac conduction system. It was first described in the 1970s, first studies were reported in the early 2000s followed by technological advances that led to its widespread uptake and growing evidence base. This retrospective study aimed to evaluate His-bundle lead implantation program in our centre. A total of 116 consecutive patients (63.8% male, 65.4 ± 13.6 years) who underwent His-bundle lead implantation in our centre from November 2018 until November 2020 were analyzed. Among these patients, over two-thirds (69.8%) had arterial hypertension, 43.1% had dyslipidemia and 29.3% had diabetes. Nearly half of patients (49.1%) had chronic heart failure, 26.7% had coronary artery disease and 8.6% had prior myocardial infarction. 40.5% of patients had atrial fibrillation. His-bundle lead implantation was achieved in 105 (90.5 %) of all patients, while the rest of the procedures were aborted and ended with right ventricle lead placement. Ten (8.6%) patients had postprocedural complications, six of which were resolved without lead extraction. Only one patient had a device-associated infection. With this analysis, we showed that the results of our His-bundle lead implantation program, regarding success and complication rates, are similar to available literature data. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Patients with myocardial infarction (MI) are treated with percutaneous intervention (PCI) followed by dual antiplatelet treatment with ticagrelor and acetyl-salicylic acid (ASA). When ticagrelor is not available or poses a high risk for the patient clopidogrel and ASA are given1. Interindividual variability of clopidogrel on platelet aggregation is widely recognized. Many studies have been conducted regarding individualized treatment with clopidogrel resulting in contradictory data. We designed a prospective, randomized study of individualized treatment with either clopidogrel or ASA or both in patients with acute MI and laboratory finding of high on treatment platelet reactivity (HOTPR). Patients and Methods: We investigated 73 patients with acute (MI) after PCI and standard loading doses of ASA and clopidogrel. Platelet reactivity was analyzed with Multiplate aggregometry. 43 patients comprised a therapeutic group with repeated daily loading doses of ASA and clopidogrel and then tailored treatment with up to 300 mg of ASA and 300 mg of clopidogrel daily. 30 patients were in the control group treated with standard treatment. Results: No significant difference in ischemic major adverse cardiovascular and cerebrovascular events (MACCE) (P=0.186) nor in overall mortality (0.521) was found when comparing the control group to the therapeutic one. However, further subanalysis revealed a higher tendency towards ischemic MACCE in the subgroup of patients with HOTPR ADP reactivity when compared to those with HOTPR ASPI reactivity (r=-0.376, P=0.013). Also, our data showed a tendency towards lower incidence of MACCE in the clopidogrel tailored subgroup (r=-0.244, P=0.078), something already shown in our previous research. When taking this into account, a significant difference in the incidence of MACCE among groups depending on all of the aforementioned therapeutic modalities is present (P=0.027). Conclusion: Our investigation showed that tailored antiplatelet therapy in patients with acute MI treated with clopidogrel and ASA and HOTPR showed no significant difference in MACCE. However, HOTPR in ADP reactivity carries greater impact on clinical outcome than HOTPR in ASPI reactivity showing tendency towards lower incidence of MACCE in patients with clopidogrel-only tailoring. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tako-Tsubo cardiomyopathy (TTC) is a clinical condition characterized by acute and generally reversible myocardial dysfunction. It is usually triggered by significant emotional or physical stress. Catecholamine activation of adrenoceptors has been recognized as a primary trigger of pathophysiological changes in TTC1. Previous data showed no evidence that cardioprotective drugs such as beta-blockers (BB) decrease reoccurrence of TTC2. We sought to evaluate whether chronic BB therapy attenuates myocardial dysfunction and type of wall motion abnormalities (WMA) in patients presenting with TTC. METHODS: We retrospectively analyzed medical record data of patients admitted with TTC from January 2011 to March 2015. Left ventricular ejection fraction (LVEF), location and extent of MWA were compared between patients previously treated with BB and patients without a BB in therapy at admission. RESULTS: Twenty-one patient with TTC was identified. Nine patients were BB users and eleven patients were BB non-users. Information on previous BB therapy was not available for one patient who was excluded from the analysis. There was no significant differences in demographic and clinical data between study groups. No statistically significant difference in LVEF and forms of WMA was found between study groups (0.425 and 1.000, respectively) (Table 1). CONCLUSION: Results indicate that previous use of BB does not attenuate the severity of myocardial dysfunction nor the type of WMA in patients presenting with TTC. These results warrant further investigation and confirmation on a larger number of patients. Time of patient presentation and echocardiographic examination should also be considered in the analysis. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Limited data are available on the outcome of primary percutaneous coronary intervention (PCI) in octogenarian patients, as the elderly are under-represented in randomized trials. This study aims to provide insights on clinical characteristics, management and outcome of the elderly and very elderly presenting with STEMI. Methods 2225 STEMI patients ≥ 70 years old (mean age 76.8 ± 5.1 years and 53.8% men) were admitted into the network of the ISACS-TC registry. Of these patients, 72.8% were ≥ 70 to 79 years old (elderly) and 27.2% were ≥ 80 years old (very-elderly). The primary end-point was 30-day mortality. Results Thirty-day mortality rates were 13.4% in the elderly and 23.9% in the very-elderly. Primary PCI decreased the unadjusted risk of death both in the elderly (OR: 0.32, 95% CI: 0.24–0.43) and very-elderly patients (OR: 0.45, 95% CI 0.30–0.68), without significant difference between groups. In the very-elderly hypertension and Killip class ≥ 2 were the only independent factors associated with mortality; whereas in the elderly female gender, prior stroke, chronic kidney disease and Killip class ≥ 2 were all factors independently associated with mortality. Factors associated with the lack of use of reperfusion were female gender and atypical chest pain in the very-elderly and in the elderly; in the elderly, however, there were some more factors, namely: history of diabetes, current smoking, prior stroke, Killip class ≥ 2 and history chronic kidney disease. Conclusions Age is relevant in the prognosis of STEMI, but its importance should not be considered secondary to other major clinical factors. Primary PCI appears to have beneficial effects in the octogenarian STEMI patients. [ABSTRACT FROM AUTHOR]