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Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.

Diabetes and its complications causes up to 9% of total mortality worldwide. Peripheral arterial disease is, in addition to cardiovascular diseases, the most common complication of diabetes with a prevalence that increases with age and the duration of diabetes. The specificity of peripheral artery disease in diabetics is the diffuse involvement of the arterial system, especially the popliteal arteries. Consequently, diabetes is still the main cause of small and large limb amputations, which, in addition to a reduction in the quality of life, significantly affects the survival of patients. Since the developed of atherosclerotic disease involves a number of complications from the professional domain of various subspecialties, such as diabetic foot, it is necessary to organize multidisciplinary teams for the diagnostic and therapeutic purposes. For this purpose, the General Hospital “Dr. Josip Benčević” in Slavonski Brod organized a multidisciplinary team with the goal of early recognition of peripheral artery disease and application of timely treatment. Experience from everyday clinical practice indicates that proper functioning of the team requires an accurate diagnostic and therapeutic algorithm to avoid long waiting lists for imaging, which includes Color Doppler and multislice computed tomography. The diagnostic algorithm was based on the ankle-brachial index, and its value and clinical picture guided and determined the degree of urgency and the type of image processing. By integrating the algorithm into the online database registry, we were able to more easily monitor the incidence rate, treatment success, and dependence on the entered variables. We hope that this approach will result in earlier detection of symptomatic disease and thus a significant reduction in lower limb amputations and, ultimately, mortality., Šećerna bolest sa svojim komplikacijama uzrokuje 9 % ukupne smrtnosti diljem svijeta. Periferna arterijska bolest, uz kardiovaskularne bolesti, najčešća je komplikacija šećerne bolesti, čija prevalencija raste s dobi i duljinom trajanja dijabetesa. Specifičnost periferne arterijske bolesti u dijabetičara jest difuzno zahvaćanje arterijskog sustava, poglavito potkoljeničnih arterija. Posljedično tomu, dijabetes je i dalje glavni uzrok malih i velikih amputacija ekstremiteta, što, uz smanjenje kvalitete života, znatno utječe i na preživljenje bolesnika. Budući da razvijena aterosklerotska bolest uključuje niz komplikacija iz stručne domene različitih užih specijalnosti, poput dijabetičkog stopala, u dijagnostici i liječenju nužno je organizirati multidisciplinarne timove. U tu svrhu u Općoj bolnici „Dr. Josip Benčević“ u Slavonskom Brodu organiziran je multidisciplinarni tim sa svrhom ranog prepoznavanja periferne arterijske bolesti te pravodobnog liječenja. Dosadašnje iskustvo iz svakodnevne kliničke prakse pokazuje da je za pravilno funkcioniranje tima nužno imati precizan dijagnostičko-terapijski algoritam kako bi se izbjegle duge liste čekanja za slikovnu obradu koja uključuje dupleks ultrazvuk i višeslojnu kompjutoriziranu tomografiju. Dijagnostički algoritam temeljio se na vrijednostima gležanjskog indeksa, a njegova vrijednost i klinička slika usmjeruju i određuju stupanj hitnosti i tip slikovne obrade. Integriranjem algoritma u on-line registar baze podataka dobili smo mogućnost lakšeg praćenja stope učestalosti, uspješnosti liječenja i ovisnosti o unesenim varijablama. Nadamo se da će takav način rada rezultirati ranijim otkrivanjem simptomatske bolesti, a time i znatnim smanjenjem amputacija donjih ekstremiteta te naposljetku i smrtnosti.

Aim: Takotsubo cardiomyopathy is a transient dysfunction of the heart muscle that occurs in response to a stressful event. A working diagnosis is mostly made for acute ischemic heart disease due to similar clinical presentation and differential diagnostic doubts. Although it is a reversible disorder of cardiac contractility, mortality rate is similar to that of an acute coronary syndrome due to the development of complications. We report the case of a patient with chronic kidney disease and the consequent development of Takotsubo cardiomyopathy, a possible pathophysiological link that has not been reported in the significant number in literature so far. Case report: An 83-year-old patient on a chronic hemodialysis program, due to the development of anginal symptoms specific for the acute coronary syndrome and with a significant increase in cardiospecific enzymes, was transferred to the Coronary care unit for the necessary invasive cardiac treatment. Echocardiographic and coronarographic findings confirmed the diagnosis of Takotsubo cardiomyopathy, which was the first case in a patient on chronic hemodialysis program in our institution. Conslusions: According to available data, about 30 cases of Takotsubo cardiomyopathy have been reported so far, indicating that transient myocardial dysfunction is a rare cardiomyopathy in patients with chronic kidney disease. A small number of literature-recorded cases do not support the similar pathophysiological basis of increased sympathetic activity present in Takotsubo cardiomyopathy and chronic kidney disease., Sažetak. Cilj: Takotsubo kardiomiopatija prolazna je disfunkcija srčanog mišića koja nastaje kao odgovor organizma na stresorni događaj. Radna se dijagnoza većinom postavlja za akutnu ishemijsku bolest srca radi slične kliničke prezentacije i diferencijalnih dijagnostičkih dvojbi. Iako se radi o reverzibilnom poremećaju srčane kontraktilnosti, smrtnost je slična akutnom koronarnom sindromu uslijed razvoja komplikacija. Izvještavamo slučaj pacijentice s kroničnom bubrežnom bolesti i posljedičnim razvojem Takotsubo kardiomiopatije, moguće patofiziološke poveznice koja do sada literaturno nije zabilježena u značajnom broju. Prikaz slučaja: 83-godišnja pacijentica na programu kronične hemodijalize, uslijed razvoja anginoznih tegoba specifičnih za akutni koronarni sindrom te uz značajan porast kardiospecifičnih enzima, premještena je u koronarnu jedinicu radi potrebne invazivne kardiološke obrade. Ehokardiografski i koronarografski nalaz potvrdio je dijagnozu Takotsubo kardiomiopatije, što je ujedno prvi zabilježen slučaj u pacijenta na programu kronične hemodijalize u našoj ustanovi. Zaključci: Prema dostupnim podatcima, do sada je zabilježeno oko 30 slučajeva Takotsubo kardiomiopatije kod bubrežnih bolesnika, što pokazuje da je prolazna disfunkcija miokarda rijetka kardiomiopatija u pacijenata s kroničnom bubrežnom bolesti. Mali broj literaturno zabilježenih slučajeva ne ide u prilog sličnoj patofiziološkoj osnovi povećane simpatičke aktivnosti prisutne kod Takotsubo kardiomiopatije i kronične bubrežne bolesti.

Sažetak Background: Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable.1, 2 Case report: 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2, 75/33mm in CxA-OM2 with POT 3, 25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2, 5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion: Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen.

Introduction: There are limited study data available of the effects of peripheral artery disease (PAD) on patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). According to the PROGRESS-CTO Registry results patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions and lower procedural success.1-3 We present the case of successful opening in stent CTO lesion of right coronary artery (RCA) in patient with PAD. Case report: 59-year-old man with a known history of a coronary vessel disease and PAD presented to our department due to frequent episodes of chest pain under minimal exercise and claudication and pain in the buttocks. The coronary angiography showed unchanged exam in left coronary basin. The RCA was completely occluded in segment two right in the area of the stent that was implanted eight years before. We found collaterals from the left coronary artery system and signs of calcification and autocollaterals for the distal segment of RCA, so the diagnostically criteria of a CTO were fulfilled. Because of the present symptoms of the patient and evidence for vital myocardium by echocardiography and myocardial scintigraphy revascularization of the CTO was performed. An AL 0.75 6F guidance catheter was used and the standard antegrade wire escalation technique attempted. A Turnpike Spiral catheter was inserted with the help of a ASAHI Fielder XT-A wire which was exchanged to an ASAHI Gaia Second which allowed the successful recanalization. Balloon angioplasty was performed with Abbot Traveler 1.5/15mm, Medtronic Euphora 2.57/15mm. Two sirolimus eluting stents (Terumo Ultimaster 3.0/38 mm and Ultimaster 3.0/30 mm) were successfully implanted with very good angiographic result. Three months later, chronic total occlusion of the left external iliac artery was treated successfully by percutaneous intervention and control coronary angiography showed unchanged exam in RCA. Conclusion: Our experience in this case demonstrates the feasibility of recanalization of an in-stent CTO in the patient with PAD and three months follow up showed improved of angina and quality of life. There is a definite and strong correlation between PAD and CAD. A concurrent PAD diagnosis is associated with higher rates of adverse outcomes following CTO PCI which requires additional monitoring.

We can calculate that 2 million interventions worldwide are performed on bifurcation lesions per year. Publication of the 12th consensus document from the European Bifurcation Club (EBC) confirms that we are still looking for perfect bifurcation treatment. Analyzing eight general consensus statements and a number of consensus documents dedicated to specific topics published by EBC, the most important question in treating bifurcation lesion (BL) is the decision whether to implant one stent or two stents (simplicity or complexity). This decision depends mostly on the operator’s subjective judgment of the true clinical relevance of a side branch. We will review the present literature on how to differentiate simple from complex BL and critical analysis of clinical studies comparing provisional vs two stent techniques. We will present real world data from our medium volume center. We conclude and suggest: 1. our reality differs from randomized controlled trials (RCT): there is a disconnection between RCT and patient-centered decision-making ; 2. EBC consensus is based on the data from RCTs done by top experts. The decision how to treat BL is largely based on the comfort and experience of the operator. Every day less experienced operators are faced with the challenge of treating complex bifurcation lesions in real world ; 3. We need data in the standard of real-world clinical practice: detailed clinical data of the patient, anatomical lesion details, all of the details of the performed procedure and wide spectrum of clinical and angiographic outcomes. These facts must be kept in mind in our search for holy grail in treating BL: technique that is fast, simple, easy, with less contrast and radiation, high success rates, low complications and good longterm results.

The acute coronary syndrome (ACS) network is a complex system of concern for patients with acute coronary syndrome. In order to provide adequate patient care, reduce total mortality and irrational costs of treatment, we need varied algorithms and a patient concern protocols. Outhospital emergency medical services, intrahospital emergency rooms, and coronary care units in percutaneous coronary intervention (PCI) and nonPCI centers participate in the care of ACS patients. Therefore, only algorithms adapted to each of these levels can improve the protocol for patient care. By standardized protocol implementation since January 2016, we compared the results with respect to the total number of patients before the protocol was applied. We analyzed the total number of patients, the relationship between the number of transferred and non-transferred patients, the intra-hospital mortality as well as the total mortality for ST- elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction patients (NSTEMI). The results show that the standardized protocol increases the total number of PCIs in patients with ACS, namely 36% for STEMI and 20% for NSTEMI. However, the total mortality of STEMI patients has increased from 5.2% to 6.9%, which is a consequence of an increased number of patients with cardiogenic shock (2.5% to 7.8%), as well as inappropriately high rates of transfer time from nonPCI hospitals (average time was 160 min). In patients with NSTEMI we recorded an increase in the total number of patients by 20%, while total mortality rate has not been changed. However, we should point out a favorable trend in the increase of PCI within 72 hours in NSTEMI patients. The standardized protocol, along with other organizational improvements, has led to the primary goal of increasing the number of primary PCIs in STEMI and PCI at ACS-NSTEMI at an early stage. It has also revealed the need for additional effort to increase the quality of treatment in terms of reducing patient delay time, proper recognition of STEMI by the outhospital emergency services, as well as the need to reduce transport time for transferred patients. If a transfer within 120 minutes cannot be provided we recommend pharmacoinvasive approach to be applied.

Complex lesions interventions are technically demanding and associated with higher rates of adverse events. In left main stenting, ostial lesions and bifurcation procedures, precise stent position, complete lesion coverage and full stent deployment (apposition) are mandatory. These procedures should be guided with other imaging modalities. Intravascular ultrasound (IVUS) is a gold standard for all these indications, but it is expensive, time consuming and carries some added per procedural risk. Clear stent imaging or stent boost is an enhancement of the radiological edge of the stent by digital management of regular X- ray images. It is a simple and fast method especially useful for proper stent positioning, control of stent deployment and apposition. During bifurcation stenting it also allows correct balloon positioning for proximal optimizing technique and correct positioning of side branch stenting in T-stenting and small protrusion technique. Recent studies investigated the accuracy of stent positioning and deployment guided with CLEARstent, compared it and also controlled it with IVUS. The results show sufficient specificity for conventional use in every day practice. We routinely started to use CLEARstent imaging in December 2015. The procedures were carried out on a Siemens Artis zee floor-mounted angiography system integrated with CLEARstent software. We present some clinical cases where we were guided with CLEARstent imaging which definitely improved success of our procedures. The method is simple and quick, and as a center without IVUS, we now routinely use it in every complex lesion intervention.

Aim: The aim was to determine soluble vascular adhesion molecule 1 (sVCAM-1) before and 24 hours after the percutaneous coronary intervention (PCI) between the group of patients treated with balloon dilatation with stent implantation, with drug- eluting balloon (DEB) and the control group, to compare the obtained differences and their relationship with clinical and procedural parameters. Patients and Methods: The study included 15 patients treated with predilatation and stenting (group A), 15 patients treated with DEB (group B) and 24 patients in the control group. We measured sVCAM-1 before the procedure and 24 hours after the procedure. We compared sVCAM-1 between groups, and their relationship with clinical and procedural parameters. Results: Group A had significantly higher sVCAM-1 in the first measurement in relation to both other groups (p < 0.05). There was a significant decrease between two measurements in the group A (p = 0.041), increase in the group B (p = 0.017), and no changes in the control group. There were no significant differences in demographic and clinical characteristics, except for a significantly smaller proportion of patients with previous myocardial infarction (MI) in control group and significantly lower average time elapsed from myocardial infarction in group B. There was positive correlation between the number of balloon inflations and the total duration of inflation and sVCAM-1 24 hours after the procedure, but not statistically significant. In the subanalysis we found no statistically significant difference in the dynamics of sVCAM-1 depending on history of earlier MI, PCI and history of statin therapy, and we noted statistically significant (p = 0.024) increase of sVCAM-1 24 h after the procedure among nondiabetic patients in group B. Conclusion: 1. significant increase in sVCAM-1 24 hours after the procedure in patients of group B could be caused by procedural differences done in groups A and B, but possible reason is in some of the characteristics of the DEB. 2. significantly higher value sVCAM-1 before the procedure in group A is because we included patients who have had a myocardial infarction less than 3 months before the intervention. 3. results of this study rejected the hypothesis on the expected lower inflammatory response in patients treated with DEB, but they provide useful information for future studies1-3 which should clarify the mechanisms of endothelial damage during PCI.

Postperikardiotomni sindrom (PPS) je klinicki sindrom koji nastaje u sklopu autoimune upalne reakcije perikarda i pleure, a klinicki se manifestira novonastalim ili pogorsanjem prisutnog perikardijalnog ili pleuralnog izljeva. Javlja se od prvog do sestog tjedna nakon kardiokiruskih zahvata i spada među najcesce komplikacije kardijalne kirurgije. Ucestalost pojavnosti bolesti je raznolika od 2-30% i ovisi o tipu kardiokirurskog zahvata.1-3 Retrospektivnom analizom PPS registra u Opcoj bolnici “Dr. Josip Bencevic” Slavonski Brod u razdoblju od 1. ožujka 2009. do 1. listopada 2015. godine ucestalost PPS- a sveukupno, neovisno o tipu kardiokiruskog zahvata, iznosila je 10, 1 % , dok je ucestalost PPS-a kod bolesnika podvrgnutih kirurgiji aortne valvule iznosila 26 %. Rutinskim probirom bolesnika dva do cetiri tjedna iza operativnog zahvata moguce je na osnovu jednostavnih dijagnostic- kih kriterija postaviti dijagnozu i zapoceti adekvatno lijecenje, s postizanjem remisije u vise od 95 % bolesnika. U dijagnostici bolesti povisen CRP i febrilitet imaju snažnu prediktivnu vrijednost te su uz prisutnost pleuralnog/perikardijalnog izljeva dovoljni kriteriji za dijagnozu bolesti. Lijecenje se provodi primjenom NSAR, kolhicina ili kortikosteroidima. Profilakticka primjena kolhicina prema COPPS studiji smanjuje ucestalost pojave PPS. Iako za sada nema jasnih preporuka za profilaksu, prema nasem istraživanju, identifikacija bolesnika s visokim rizikom na osnovu tipa operacije, dobi i drugih klinickih parametara podupire hipotezu o korisnosti profilakse.

Background: Current evidence clearly show that patients with ST-segment elevation myocardial infarction (STEMI) should be pretreated with dual antiplatelet therapy (DAPT) and anticoagulation therapy immediately after confirmed diagnosis, and that pretreatment can be even performed safely prehospitally. In non ST-segment elevation myocardial infarction (NSTEMI), recommendations are not so clear, with data showing that pretreatment depends on what combination of DAPT is used and what is the risk profile of the patient. Also, less than 70% of all patients with NSTEMI undergo stenting after coronary angiography whereas the rest continue medical treatment or are scheduled for coronary artery bypass graft surgery. We present our data on anticoagulation and platelet antiaggregation therapy selection and timing in patients with STEMI and NSTEMI scheduled for early invasive approach, that were collected using our acute coronary syndrome flow chart, and compare them to current guidelines. Patients and Methods: Standardized prospective flow chart was utilized to collect data on medical and interventional treatment of patients with STEMI and NSTEMI scheduled for early coronary angiography in 2016. Registry data from 2014 and 2015 were used as comparison. Results: Data showed that all patients with STEMI received pretreatment with either clopidogrel (in 2014) or ticagrelor (in 2015 and 2016) and unfractionated heparin, but only in-hospital. Only aspirin was administered prehospitally. Patients with NSTEMI received enoxaparine, fondaparinux or unfractionated heparin, mostly before coronary angiography. Clopidogrel was administered before coronary angiography in all patients with NSTEMI in 2014 and 2015, whereas patients with NSTEMI in 2016 received ticagrelor, mostly before angiography. In 2016 there were nearly 10% of patients that were treated with ticagrelor after early coronary angiography, with no thrombotic complications. Conclusions: STEMI pretreatment should be done as early as possible, and standardized protocols should encourage early detection and prehospital administration. NSTEMI protocols are however unclear, there are cases with unsupported mixing of anticoagulants before and during invasive treatment. Choice of antiplatelets and their timing of administration is still unclear in NSTEMI and requires further investigation.

Background: Optimal results of primary percutaneous coronary intervention (PCI) in acute ST-segment elevation myocardial infarction (STEMI) are sometimes challenged by large thrombotic burden. TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial Infarction Study) trial in 2008 first showed that thrombus aspiration in STEMI patients with large thrombotic burden improved overall survival after 1 year.1 Later on in 2013, Thrombus Aspiration in ST- Elevation Myocardial Infarction in Scandinavia (TASTE) trial, a prospective national registry showed no benefitof routine thrombectomy in STEMI.2 2012 European Society of Cardiology (ESC) Guidelines for the management of STEMI, that are currently available, gave a strong recommendation (IIaB) for manualthrombectomy in STEMI.3 However, that recommendation was downgraded to IIbA after TASTE trial in 2014 ESC Guidelines on myocardial revascularization.4 Here, we present the data on thrombus aspiration utilization within the Western Slavonia Primary PCI network, and compare the results between pre-TASTE and post-TASTE era. Patients and Methods: Data on primary PCI techniques to achieve Thrombolysis in Myocardial Infarction (TIMI) 3 flow, on utilization of the glycoprotein IIb/IIIa inhibitors, and on clinical outcomes in STEMI were collected in 2012 and 2013, and compared to data from 2014 and 2015. Results: In 2012 and 2013, out of 114 patients that underwent primary PCI in STEMI 32% received thrombusaspiration, out of whom 61% had thrombus aspiration in the right coronary artery. Overall TIMI 3 rate was 88%, and overall in-hospital mortality was 6.1%. In 2014 and 2015 there were 253 patients with primary PCI in STEMI, with only 17% of thrombectomy cases (68% of cases were done in the right coronary artery). Overall TIMI 3 rate was 91%, and in-hospital mortality 5.9%. Conclusion: Thrombectomy penetration dropped significantly, together with the glycoprotein IIb/IIIa inhibitors use after publication of TASTE trial. Patients that received thrombectomy in 2014 and 2015 had mainly high thrombotic burden in the right coronary artery, or had embolic myocardial infarction. There were no changes in TIMI 3 achievement and in-hospital mortality. Manual thromboaspiration remains a useful tool only in selected population of patients with highly thrombotic lesions, aneurysmal coronary artery disease or embolic myocardial infarction.

Uvod: S obzirom na to da ekstraskeletni ucinci vitamina D, posebice njegova uloga u održavanju kardiovaskularnog sustava dobivaju sve vise pažnje, cilj je bio odrediti serumsku koncentraciju vitamina D u ispitanika s akutnim koronarnim sindromom i u kontrolnoj skupini. Pacijenti i metode: U istraživanje su ukljuceni bolesnici lijeceni zbog akutnog koronarnog sindroma (AKS) na Odjelu kardiologije OB , , Dr J. Bencevic'' u Slavonskom Brodu i kontrolna skupina ispitanika koji nisu do ukljucenja lijeceni zbog bilo kakvog oblika koronarne bolesti srca(KBS). Skupinu ispitanika s AKS-om cini 60 bolesnika (40 muskaraca, srednja dob 58) hospitaliziranih zbog AKS-a i podvrgnuti koronarnoj angiografiji i revaskularizacijskim postupcima. Kontrolnu skupinu cini 60 bolesnika (38 muskaraca, srednja dob 58, 5), bez AKS-a, ali uz prisutan barem jedan klasicni cimbenik rizika za kardiovaskularne bolesti. Serumska vrijednost 25-hidroksi vitamina D određivala se elektrokemiluminiscentnom metodom. Insuficijencija vitamina D je definirana kao razina 25-hidroksivitamin D u plazmi ≤50nmol/L. Rezultati: Nije bilo znacajne razlike u demografskim i relevantnim klinickim obilježjima između bolesnika s AKS-om i kontrola. Prosjecna vrijednost koncentracije vitamina D izmjerene u bolesnika s AKS-om iznosila je 35, 19 nmol/L uz (SD 17, 54) i bila je statisticki znacajno niža u usporedbi s kontrolnom skupinom ispitanika cija je prosjec- na vrijednost iznosila 58, 08 nmol/L uz (SD 16, 29) (Student T-test, p˂0, 001). Vrijednosti vitamina D kod pacijenata s infarktom miokarda s elevacijom ST-segmenta su niži u odnosu na infakt miokarda bez elevacije ST-segmenta (Student t- test, p=0, 702). Bolesnici s visežilnom bolesti imali su najniže izmjerene vrijednosti vitamina D. Zakljucak: Razina vitamina D znacajno je niža u bolesnika s AKS-om u usporedbi s kontrolnom skupinom. Postoji trend prema nižim razinama vitamina D s povecanjem težine KBS, no te razlike nisu statisticki znacajne. Potrebne su daljnje studije na vecem broju ispitanika koje ce potvrditi nase rezultate.

*ADDRESS fOR CORRESpONDENCE: Opca bolnica „Dr. Josip Bencevic“, Andrije Stampara 42, HR-35000 Slavonski Brod, Croatia. / Phone: +385-1-35-201-689 / E-mail: irzalh@gmail.com Usporedba ucinkovitosti i sigurnosti između tikagrelora s heparinom i klopidogrela s heparinom ili enoksaparinom prije primarne perkutane koronarne intervencije u akutnom infarktu miokarda — prva iskustva iz mreže zapadne Slavonije

Introduction and goal: The latest 2011 non-ST- segment elevation acute coronary syndromes (NSTE- ACS) management guidelines indicated that all patients should receive anticoagulation drugs irrespective of the treatment strategy. In this report, 2-year data on anticoagulation therapies for NSTE-ACS are presented, in relation to invasive management selection and treatment outcomes in a clinical setting without registered bivalirudin. Patients and Methods: Data for 374 patients with NSTEACS treated in the Coronary Care Unit in General Hospital Slavonski Brod, Croatia were analyzed from January 2012 to December 2013. Treatment strategies, outcomes and complications among patients treated with different anticoagulation agents (enoxaparine, fondaparinux or unfractionated heparin) were analyzed and compared. Results: In all, 72% of all NSTE-ACS patients were treated invasively, out of which 66% underwent angiography within 72 hours. Urgent and early angiography was performed in 44% of all invasively treated patients. Generally, 58% and 5% of patients received enoxaparine and unfractionated heparin (UFH), respectively, whereas fondaparinux was administered in 37% of patients. Median age of patients treated with enoxaparine was 66, compared to 76 in the fondaparinux group. There were significantly more patients treated with enoxaparine and UFH than with fondaparinux in the invasive strategy group. We observed that the number of patients treated with fondaparinux in the invasive group increased together with the period between symptom onset and angiography. The number of patients treated conservatively with either fondaparinux or enoxaparine was almost equal. There were no patients treated conservatively with UFH. In general, in-hospital mortality was low, 2.6% with no significant differences in bleeding events regarding the selection of anticoagulation therapy. Conclusions: Although the guidelines gave preference to fondaparinux, everyday practice in our hospital showed that enoxaparine was a preferred agent, particularly in younger patients selected for early invasive strategy, most probably because of the risk/benefit ratio and opportunity of avoiding the mixing of anticoagulation agents. Only 5% of patients were selected for urgent invasive approach with UFH, which should probably increase in the future. Considering a higher cost of bivalirudin, the introduction of this agent for non-ST segment elevation myocardial infarction management does not seem to be mandatory in our clinical setting, since this small group of patients was adequately managed with UFH.