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Coronary Artery Disease: HELP
Articles from Serbia
Based on 100 articles published since 2008
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These are the 100 published articles about Coronary Artery Disease that originated from Serbia during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Consensus from the 7th European Bifurcation Club meeting. 2013

Stankovic, Goran / Lefèvre, Thierry / Chieffo, Alaide / Hildick-Smith, David / Lassen, Jens Flensted / Pan, Manuel / Darremont, Olivier / Albiero, Remo / Ferenc, Miroslaw / Finet, Gérard / Adriaenssens, Tom / Koo, Bon-Kwon / Burzotta, Francesco / Louvard, Yves / Anonymous4720754. ·Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. gorastan@sbb.rs ·EuroIntervention · Pubmed #23552575.

ABSTRACT: -- No abstract --

2 Guideline Percutaneous coronary intervention for bifurcation lesions: 2008 consensus document from the fourth meeting of the European Bifurcation Club. 2009

Stankovic, Goran / Darremont, Olivier / Ferenc, Miroslaw / Hildick-Smith, David / Louvard, Yves / Albiero, Remo / Pan, Manuel / Lassen, Jens Flensted / Lefèvre, Thierry / Anonymous860633. ·Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia. gorastan@sbb.rs ·EuroIntervention · Pubmed #19577982.

ABSTRACT: -- No abstract --

3 Editorial 2017 ESC guidelines focus on dual antiplatelet therapy. 2018

Rosano, Giuseppe M C / Seferovic, Petar. ·Clinical Academic Group Cardiovascular, St George's Hospitals NHS Trust University of London, UK. · IRCCS San Raffaele, Roma, Italy. · Department of Cardiology, University of Belgrade, Belgrade, Serbia. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #30052849.

ABSTRACT: -- No abstract --

4 Editorial Is there any relationship between cardiopulmonary capacity and cardiovascular mechanics in coronary artery disease? 2016

Tadic, Marijana / Cuspidi, Cesare. ·University Clinical Hospital Centre "Dr. Dragisa Misovic - Dedinje", School of Medicine, University of Belgrade; Belgrade-Serbia. marijana_tadic@hotmail.com. · University of Milan-Bicocca and Instituto Auxologico Italiano, Clinical Research Unit; Meda-Italy. ·Anatol J Cardiol · Pubmed #27716726.

ABSTRACT: -- No abstract --

5 Review Delivering ultimate bifurcation treatment. 2018

Mehmedbegovic, Zlatko H / Vukcevic, Vladan D / Stankovic, Goran R. ·Department of Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. · Department of Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia - gorastan@sbb.rs. ·Minerva Cardioangiol · Pubmed #29527865.

ABSTRACT: Coronary bifurcation lesions are accounted in about 20% of all percutaneous coronary interventions and despite all-round improvements in their treatment are still perceived as complex lesion subset in interventional cardiology. Treatment of bifurcations, being technically demanding primarily due to the unique bifurcation anatomy, is related to lower procedural success rate and increased rates of long-term adverse cardiac events. According to published data, provisional approach remains a default strategy for majority of bifurcation PCI, but when perfected, two-stent bifurcation techniques can also yield good clinical outcomes. In this paper, we summarize in stepwise fashion technical aspects of optimal, evidence-based bifurcation treatment aiming to accomplish best procedural results and favorable long-term prognosis.

6 Review Step-by-step manual for planning and performing bifurcation PCI: a resource-tailored approach. 2018

Milasinovic, Dejan / Wijns, William / Ntsekhe, Mpiko / Hellig, Farrel / Mohamed, Awad / Stankovic, Goran. ·Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia. ·EuroIntervention · Pubmed #29175768.

ABSTRACT: As bifurcation PCI can often be resource-demanding due to the use of multiple guidewires, balloons and stents, different technical options are sometimes being explored, in different local settings, to meet the need of optimally treating a patient with a bifurcation lesion, while being confronted with limited material resources. Therefore, it seems important to keep a proper balance between what is recognised as the contemporary state of the art, and what is known to be potentially harmful and to be discouraged. Ultimately, the resource-tailored approach to bifurcation PCI may be characterised by the notion of minimum technical requirements for each step of a successful procedure. Hence, this paper describes the logical sequence of steps when performing bifurcation PCI with provisional SB stenting, starting with basic anatomy assessment and ending with the optimisation of MB stenting and the evaluation of the potential need to stent the SB, suggesting, for each step, the minimum technical requirement for a successful intervention.

7 Review Treatment of Bifurcation Lesions by Bail-Out TAP or Culotte: Lost in Translation? 2017

Burzotta, Francesco / Lefevre, Thierry / Lassen, Jens Flensted / Holm, Niels Ramsing / Stankovic, Goran. ·Institute of Cardiology, Catholic University of the Sacred Heart, 00168 Rome. Italy. · Ramsay-Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques Cartier, Massy. France. · Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen. Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus N. Denmark. · Department of Cardiology, Clinical Center of Serbia and Medical Faculty, University of Belgrade, Belgrade. Serbia. ·Rev Recent Clin Trials · Pubmed #28462716.

ABSTRACT: BACKGROUND: Coronary bifurcated lesions (CBL) represent a hot topic of interventional cardiology. Provisional stenting, i.e. implantation of a drug-eluting (DES) in the main branch followed by side-branch (SB) intervention in case of suboptimal SB result, represents the gold standard to treat the vast majority of CBL undergoing percutaneous coronary interventions (PCI). The best technique for bail-out SB stenting has not been established. Prospective randomized trials comparing different stenting techniques may help provide important insights regarding the best way to conduct PCI in patients with CBL. METHODS: The recently published Bifurcations Bad Krozingen (BBK) II trial is the last important randomized study in the field of bifurcation PCI and is focused on the search for the best management of those patients with suboptimal SB result during provisional stenting. Two different SB implantation strategies after provisional stenting have been compared. In the present manuscript, we employed BBK II results in the context of available literature highlighting important specific features of the study with main emphasis on patient selection process and techniques applied.

8 Review Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation. 2015

Antoniadis, Antonios P / Mortier, Peter / Kassab, Ghassan / Dubini, Gabriele / Foin, Nicolas / Murasato, Yoshinobu / Giannopoulos, Andreas A / Tu, Shengxian / Iwasaki, Kiyotaka / Hikichi, Yutaka / Migliavacca, Francesco / Chiastra, Claudio / Wentzel, Jolanda J / Gijsen, Frank / Reiber, Johan H C / Barlis, Peter / Serruys, Patrick W / Bhatt, Deepak L / Stankovic, Goran / Edelman, Elazer R / Giannoglou, George D / Louvard, Yves / Chatzizisis, Yiannis S. ·Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. · FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. · California Medical Innovations Institute, San Diego, California. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy. · National Heart Centre Singapore, Singapore. · Department of Cardiology and Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan. · Cardiovascular Division, Department of Internal Medicine, Saga University, Saga, Japan. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy; Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Melbourne Medical School and Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia. · International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Institut Cardiovasculaire Paris Sud, Massy, France. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. Electronic address: ychatzizisis@icloud.com. ·JACC Cardiovasc Interv · Pubmed #26315731.

ABSTRACT: Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

9 Review When and how to use BRS in bifurcations? 2015

Stankovic, Goran / Lassen, Jens Flensted. ·Department of Cardiology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia. ·EuroIntervention · Pubmed #25983163.

ABSTRACT: Bioresorbable coronary scaffolds (BRS) may offer potential advantages compared to metallic DES, aiming to restore vessel patency without implanting a permanent prosthesis, which may be especially important for bifurcation treatment. On the other hand, there are some inherent limitations, which may impact on the widespread use of BRS. In the current article we discuss the bench testing data and initial clinical results on BRS use in bifurcation lesions presented during European Bifurcation Club (EBC) meetings and review some of the limited number of published real-world registry results.

10 Review Percutaneous coronary intervention for stable patients: is there any benefit beyond symptom relief? 2009

Stankovic, Goran. ·Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrado, Sérvia. gorastan@sbb.rs ·Arq Bras Cardiol · Pubmed #19838499.

ABSTRACT: The indications for percutaneous coronary intervention (PCI) continue to evolve because of the steady improvement in technology, broadened patient and lesion selection criteria, and new evidence from clinical trials. Considerable controversy was generated by the main results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, in which no difference in long-term outcome was reported for stable patients with coronary disease randomized to an initial strategy of PCI plus optimal medical therapy versus optimal medical therapy alone. In patients with chronic stable angina, medical therapy remains the cornerstone and should be optimized for all patients, while the major achievable goals of PCI are to affect symptoms, either by decreasing or preventing them, reducing the need for subsequent procedures and relieving ischemia. In patients with stable coronary artery disease, however, no reduction in death or myocardial infarction has been observed, and these limitations of PCI in this clinical setting need to be emphasized. The message from the COURAGE trial may be refined based on recently presented nuclear and angiographic sub-studies, such that patients with substantial residual ischemia on optimal medical therapy should be considered for crossover PCI, as it is associated with greater likelihood of death and myocardial infarction. However, those findings need to be confirmed by prospective evaluation before being widely accepted by the interventional community.

11 Review Homocysteine, folic acid and coronary artery disease: possible impact on prognosis and therapy. 2008

Djuric, D / Jakovljevic, V / Rasic-Markovic, A / Djuric, A / Stanojlovic, O. ·Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia. drdjuric@EUnet.yu ·Indian J Chest Dis Allied Sci · Pubmed #18610689.

ABSTRACT: Within the past four decades, the efforts of investigators worldwide have established the amino acid homocysteine (Hcy) as an important factor in arteriosclerosis and ageing. The amino acid homocysteine is a unique candidate for the study of different age-related pathological conditions, namely vascular diseases, dementia disorders and late-life depression, due to its multiple roles in different pathways leading to atherosclerosis and neurotoxicity. Especially, the role of homocysteine in predicting risk for atherothrombotic vascular disease has been evaluated in several observational studies in a large number of patients. These studies show that the overall risk for vascular disease is small, with prospective, longitudinal studies reporting a weaker association between homocysteine and atherothrombotic vascular disease compared to retrospective case-control and cross-sectional studies. Furthermore, randomised controlled trials of homocysteine-lowering therapy have failed to prove a causal relationship. On the basis of these results, there is currently insufficient evidence to recommend routine screening and treatment of elevated homocysteine concentrations with folic acid and other vitamins to prevent atherothrombotic vascular disease.

12 Clinical Trial Population Pharmacokinetic Analysis of Bisoprolol in Patients with Stable Coronary Artery Disease. 2018

Nikolic, Valentina N / Jankovic, Slobodan M / Deljanin-Ilic, Marina / Stojanovic, Sanja S / Nikolic, Miroslav Lj / Zivanovic, Slavoljub / Stokanovic, Dragana / Jevtovic-Stoimenov, Tatjana / Milovanovic, Jasmina R. ·Department of Pharmacology and Toxicology, Faculty of Medicine, University of Nis, Medicinski fakultet, Katedra za farmakologiju sa toksikologijom, Bulevar dr Zorana Djindjica 81, 18000, Nis, Serbia. valentina@medfak.ni.ac.rs. · Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia. · Department of Cardiology, Faculty of Medicine, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. · Institute of Treatment and Rehabilitation, Faculty of Medicine, University of Nis, Srpskih junaka 2, Niska Banja, Serbia. · Laboratory for Functional Genomics and Proteomics, Research Center for Biomedicine, Faculty of Medicine, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. · Department of Pharmacology and Toxicology, Faculty of Medicine, University of Nis, Medicinski fakultet, Katedra za farmakologiju sa toksikologijom, Bulevar dr Zorana Djindjica 81, 18000, Nis, Serbia. · Department of Biochemistry, Faculty of Medicine, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. ·Eur J Drug Metab Pharmacokinet · Pubmed #28577178.

ABSTRACT: BACKGROUND AND OBJECTIVES: Bisoprolol is a selective beta adrenergic antagonist commonly used in treatment of coronary artery disease (CAD). The aim of our analysis was to estimate and identify different factors that could affect bisoprolol clearance (CL) and develop a population pharmacokinetic model in patients with stable coronary artery disease (CAD). METHODS: Population pharmacokinetic analysis was performed by using sixty-six plasma concentrations from the same number of patients (mean age 60.26 ± 9.68 years; mean total body weight 80.37 ± 12.93 kg) with CAD. We examined the effects of various clinical and demographic parameters using nonlinear mixed-effect modeling (NONMEM) with ADVAN1 with TRANS2 subroutine. The pharmacokinetics of bisoprolol in patients with CAD were suitably defined by an oral one-compartment model. RESULTS: The typical mean value for bisoprolol CL, estimated by the base model, in the target population was 6.76 l/h. The only demographic covariate which affected bisoprolol pharmacokinetic variability was creatinine clearance (CLcr). The final model of bisoprolol clearance was described by following equation: CL (l/h) = 2.83 + 0.0385 × CLcr (ml/min). Validation of the final model was performed in a group of 17 patients using the validation set and bootstrapping analysis. CONCLUSIONS: These findings suggest that one of the causes of clearance of bisoprolol variability in patients with CAD is the difference in renal function.

13 Clinical Trial Incidence, predictors, and 30-day outcomes of new-onset atrial fibrillation after primary percutaneous coronary intervention: insight into the RISK-PCI trial. 2012

Mrdovic, Igor / Savic, Lidija / Krljanac, Gordana / Perunicic, Jovan / Asanin, Milika / Lasica, Ratko / Antonijevic, Nebojsa / Kocev, Nikola / Marinkovic, Jelena / Vasiljevic, Zorana / Ostojic, Miodrag. ·University of Belgrade School of Medicine, Belgrade, Serbia. igormrd@gmail.com ·Coron Artery Dis · Pubmed #22107800.

ABSTRACT: OBJECTIVES: Limited data exist about the prognostic significance of new-onset atrial fibrillation (AF) after contemporary primary percutaneous coronary intervention (pPCI). The objective of this study was to identify the incidence and predictors of new-onset AF and associated adverse 30-day outcomes in AF patients who underwent pPCI. METHODS: We analyzed 2096 patients undergoing pPCI after pretreatment with 600 mg clopidogrel. Composite 30-day major adverse cardiovascular events were the primary end point. A logistic regression model was developed to identify risk factors for the occurrence of AF and prediction of its impact on 30-day outcomes. RESULTS: AF occurred in 6.2% of patients. Older age, Killip >1 heart failure at admission, systolic blood pressure of greater than 100 mmHg at admission, creatinine clearance greater than 60 ml/min, preprocedural infarction-related artery occlusion and postprocedural thrombolysis in myocardial infarction flow less than 3 were identified as independent predictors of the occurrence of AF. Rates of 30-day major adverse cardiovascular events [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI): 1.47-3.87] and 30-day death (adjusted OR 2.67, 95% CI: 1.46-4.89) were higher in AF patients compared with patients without AF. A trend toward higher rate of ischemia-driven target vessel revascularization was observed in the AF group (adjusted OR 2.61, 95% CI: 0.82-8.39, P=0.10). CONCLUSION: New-onset AF after pPCI is associated with adverse 30-day outcomes. Accurate prediction of AF after pPCI might help deciding a more aggressive treatment approach aimed at preventing the adverse prognosis of these patients.

14 Clinical Trial The pharmacokinetics of Biolimus A9 after elution from the BioMatrix II stent in patients with coronary artery disease: the Stealth PK Study. 2011

Ostojic, Miodrag C / Perisic, Zoran / Sagic, Dragan / Jung, Robert / Zhang, Yan-Ling / Bendrick-Peart, Jamie / Betts, Ronald / Christians, Uwe / Anonymous4260675. ·Medical School, University of Belgrade and Clinical Center of Serbia, Division of Cardiology, Dr Subotic street 8, 11000, Belgrade, Serbia. mostojic2003@yahoo.com. · Clinical Centre Nis, Nis, Serbia. · Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia. · Institute for Cardiovascular Disease, Sremska Kamenica, Serbia. · Clinical Research & Development, Department of Anesthesiology, University of Colorado Denver, Denver, CO, USA. · Eurofins Medinet, Aurora, CO, USA. · Biosensors International-USA, Newport Beach, CA, USA. ·Eur J Clin Pharmacol · Pubmed #20963405.

ABSTRACT: OBJECTIVES: This prospective, open-label multicenter study was conducted to assess the pharmacokinetics of Biolimus A9 after elution from BioMatrix II coronary stents. Recent clinical trials have demonstrated the efficacy and safety of Biolimus A9 eluted from different stent platforms. To date, the pharmacokinetics of Biolimus A9 in patients following the deployment of BioMatrix II stents has not yet been studied METHODS: BioMatrix II stents were implanted into 27 patients with coronary artery disease. The primary endpoints of the study were the systemic concentrations of Biolimus A9 after 28 days and 6 months as measured using a sensitive validated liquid chromatography-tandem mass spectrometry assay. RESULTS: The highest measured blood concentration at any time point was 394 pg/mL. At 28 days and 6 months following stent placement, 51.8 and 100% of patients, respectively, had Biolimus A9 concentrations <10 pg/mL. After 9 months, 100% of the patients were free of major cardiac adverse events (MACE). There was no Biolimus A9 toxicity, no cardiac or non-cardiac deaths, no myocardial infarctions, nor target vessel or target lesion revascularizations during the 9 months of follow-up. No case of acute, subacute, or late stent thrombosis was detected. CONCLUSIONS: Compared to other drug-eluting stents, such as Cypher, BioMatrix II results in relatively low systemic exposure, which may be explained by the ablominal coating of the Biomatrix II stent in combination with Biolimus A9's high lipophilicity.

15 Clinical Trial The pharmacokinetics of Biolimus A9 after elution from the Nobori stent in patients with coronary artery disease: the NOBORI PK study. 2008

Ostojic, Miodrag / Sagic, Dragan / Jung, Robert / Zhang, Yan-Ling / Nedeljkovic, Milan / Mangovski, Ljupco / Stojkovic, Sinisa / Debeljacki, Dragan / Colic, Mirko / Beleslin, Branko / Milosavljevic, Bratislav / Orlic, Dejan / Topic, Dragan / Karanovic, Nevena / Paunovic, Dragica / Christians, Uwe / Anonymous6340615. ·Division of Cardiology, Clinical Centre Serbia, Belgrade, Serbia. miodrag.ostojic@kcs.ac.yu ·Catheter Cardiovasc Interv · Pubmed #19016466.

ABSTRACT: OBJECTIVES: The aim of this study was to assess the pharmacokinetics and tolerability of Biolimus A9 eluted from Nobori coronary stents. BACKGROUND: : The release kinetics and pharmacokinetics of drugs delivered via coronary stents have been shown to play an essential role in the efficacy and safety of drug eluting stents. METHODS: Twenty patients with coronary artery disease were treated with single 14-mm (10 patients) or 28-mm long stent (10 patients). Blood samples were drawn at 16 time points to determine the pharmacokinetics of Biolimus A9. At seven time points, complete laboratory and toxicology panels were assessed to screen for potential Biolimus A9 toxicity. The primary endpoint of the study was the systemic blood concentrations of Biolimus A9 after 28 days and 6 months as measured using highly specific and sensitive liquid chromatography- tandem mass spectrometry assay. RESULTS: At 28 days, 6 patients (30%) had quantifiable Biolimus A9 concentrations in blood. The highest Biolimus A9 blood concentration measured in any sample was 32.2 pg/mL. The median time to maximum concentration was 2 hr, ranging from 0.05 hr to 3 months. Six months after stent implantation, only 1 of 20 patients had measurable Biolimus A9 concentrations at the lowest level of quantification, while at 9 months no sample had quantifiable Biolimus A9 concentrations. Laboratory and toxicology assessments did not indicate any impact of Biolimus A9 on the evaluated parameters. CONCLUSION: Results of this study suggest that systemic exposure to Biolimus A9 was very low and that Biolimus A9 was well tolerated.

16 Article Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. 2019

Landoni, Giovanni / Lomivorotov, Vladimir V / Nigro Neto, Caetano / Monaco, Fabrizio / Pasyuga, Vadim V / Bradic, Nikola / Lembo, Rosalba / Gazivoda, Gordana / Likhvantsev, Valery V / Lei, Chong / Lozovskiy, Andrey / Di Tomasso, Nora / Bukamal, Nazar A R / Silva, Fernanda S / Bautin, Andrey E / Ma, Jun / Crivellari, Martina / Farag, Ahmed M G A / Uvaliev, Nikolay S / Carollo, Cristiana / Pieri, Marina / Kunstýř, Jan / Wang, Chew Yin / Belletti, Alessandro / Hajjar, Ludhmila A / Grigoryev, Evgeny V / Agrò, Felice E / Riha, Hynek / El-Tahan, Mohamed R / Scandroglio, A Mara / Elnakera, Abeer M / Baiocchi, Massimo / Navalesi, Paolo / Shmyrev, Vladimir A / Severi, Luca / Hegazy, Mohammed A / Crescenzi, Giuseppe / Ponomarev, Dmitry N / Brazzi, Luca / Arnoni, Renato / Tarasov, Dmitry G / Jovic, Miomir / Calabrò, Maria G / Bove, Tiziana / Bellomo, Rinaldo / Zangrillo, Alberto / Anonymous2461128. ·From the Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute (G.L., F.M., R.L., N.D.T., M.C., M.P., A.B., A.M.S., M.G.C., A.Z.), and Vita-Salute San Raffaele University (G.L., A.Z.), Milan, Istituto di Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Padua (C.C.), Anesthesia and Intensive Care Department, University Campus Bio-Medico of Rome (F.E.A.), and Anestesia e Rianimazione, Dipartimento Cardiovascolare, Azienda Ospedaliera San Camillo Forlanini (L.S.), Rome, the Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, University Hospital Policlinico S. Orsola, Bologna (M.B.), Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Graecia di Catanzaro, Catanzaro (P.N.), Anestesia e Terapia Intensiva Cardiochirurgica, Istituto Clinico Humanitas, Rozzano (G.C.), the Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, and the Department of Surgical Sciences, University of Turin, Turin (L.B.), and the Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine (T.B.) - all in Italy · the Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk (V.V. Lomivorotov, V.A.S., D.N.P.), the Departments of Anesthesiology and Intensive Care (V.V.P.) and Cardiac Surgery (D.G.T.), Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, the Department of Anesthesia and Intensive Care, First Moscow State Medical University (V.V.P., V.V. Likhvantsev), and the Department of Intensive Care, Moscow Regional Clinical and Research Institute (V.V. Likhvantsev), Moscow, the Department of Anesthesia and Intensive Care, Ural Institute of Cardiology, Ekaterinburg (A.L.), the Laboratory for Anesthesiology and Intensive Care, Almazov National Medical Research Center, Saint Petersburg (A.E.B.), and the Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo (E.V.G.) - all in Russia · the Anesthesia Section, Department of Surgery, Dante Pazzanese Institute of Cardiology (C.N.N.), the Department of Cardiopneumology, Instituto do Coração, Universidade de São Paulo, and the Intensive Care Unit, Hospital SirioLibanes (L.A.H.), and the Cardiac Surgery Section, Department of Surgery, Dante Pazzanese Institute of Cardiology (R.A.), São Paulo, Brazil · the Department of Cardiovascular Anesthesiology and Intensive Care Medicine, and the Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb (N.B.), and the Department of Biomedical Sciences, University North, Varaždin (N.B.) - both in Croatia · the Department of Anesthesia and Intensive Care, Cardiovascular Institute Dedinje (G.G., M.J.), and the School of Medicine, University of Belgrade (M.J.), Belgrade, Serbia · the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi (C.L.), and the Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing (J.M.) - both in China · the Cardiothoracic Intensive Care Unit and Anesthesia Department, Mohammed Bin Khalifa Cardiac Center, Riffa, Bahrain (N.A.R.B.) · the Department of Anesthesiology, Hospital de Santa Maria, Lisbon, Portugal (F.S.S.) · the Department of Anesthesia, King Abdullah Medical City-Holy Capital, Makkah (A.M.G.A.F.), and the Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam (M.R.E.-T.) - both in Saudi Arabia · Anesthesia and Intensive Care, Acibadem City Clinic-Cardiac Surgery Center, Burgas, Bulgaria (N.S.U.) · the Department of Anesthesiology, Resuscitation and Intensive Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital (J.K.), and the Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine (H.R.), Prague, Czech Republic · the Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.) · the Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University Hospitals, Zagazig (A.M.E.), and the Department of Anesthesia and Surgical Intensive Care, Mansoura University, Mansoura (M.A.H.) - both in Egypt · and the School of Medicine, University of Melbourne, Melbourne, VIC, Australia (R.B.). ·N Engl J Med · Pubmed #30888743.

ABSTRACT: BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS: A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS: Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).

17 Article The association of clopidogrel and 2-oxo-clopidogrel plasma levels and the 40 months clinical outcome after primary PCI. 2018

Pavlovic, Milan / Apostolovic, Svetlana / Stokanovic, Dragana / Lilic, Jelena / Konstantinovic, Sandra S / Zvezdanovic, Jelena B / Marinkovic, Valentina / Nikolic, Valentina N. ·Department of Internal Medicine-Cardiology, Medical Faculty, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. · Clinic for Cardiovascular Diseases, Clinical Centre Nis, Bulevar dr Zorana Djindjica 48, Nis, Serbia. · Department of Pharmacology and Toxicology, Medical Faculty, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. · Medical Faculty, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. · Department of Chemistry, Faculty of Technology, University of Nis, Bulevar oslobodjenja 124, Leskovac, Serbia. · Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belegrade, Vojvode Stepe 450, Belgrade, Serbia. · Department of Pharmacology and Toxicology, Medical Faculty, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia. valentina@medfak.ni.ac.rs. · Medicinski fakultet, Bulevar dr Zorana Djindjica 81, Nis, 18 000, Serbia. valentina@medfak.ni.ac.rs. ·Int J Clin Pharm · Pubmed #30367373.

ABSTRACT: Background A significant number of ischemic events occur even when adhering to dual antiplatelet therapy including aspirin and clopidogrel. Objectives The aim of our study was to determine predictors of long-term patient clinical outcome, among variables such as prodrug clopidogrel and intermediary metabolite 2-oxoclopidogrel concentrations, as well as patients' clinical characteristics. Setting Department for the Treatment of Acute Coronary Syndrome in tertiary teaching hospital, Serbia. Methods This study enrolled 88 consecutive patients with first STEMI, treated with primary PCI, within 6 h of the chest pain onset and followed them 40 months. On the third day of hospitalization, blood samples were collected from each patient to measure clopidogrel and its metabolite 2-oxo-clopidogrel concentration by UHPLC-DAD-MS method. Main outcome measure Mortality from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke or hospitalization for urgent myocardial revascularization or heart failure. Results The composite clinical outcome of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for urgent myocardial revascularization or heart failure, was registered in 31 patients (35.2%) during the 40-month follow-up. Lower clopidogrel (p < 0.05) and dose-adjusted clopidogrel concentrations (p < 0.05) were associated with the higher incidence of composite outcome events. Their low plasma concentrations may be predicted by fentanyl administration (p < 0.001) and creatinine clearance (p < 0.01). The decrease in dose-adjusted clopidogrel unit for each ng/ml/mg increases the risk 21.7 times (p < 0.05). Conclusion Clopidogrel dose-adjusted plasma concentration in STEMI patients, as well as multivessel coronary artery disease, showed significance in predicting an unfavorable composite clinical outcome after 40-month follow-up.

18 Article Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. 2018

Gaudino, Mario / Benedetto, Umberto / Fremes, Stephen / Biondi-Zoccai, Giuseppe / Sedrakyan, Art / Puskas, John D / Angelini, Gianni D / Buxton, Brian / Frati, Giacomo / Hare, David L / Hayward, Philip / Nasso, Giuseppe / Moat, Neil / Peric, Miodrag / Yoo, Kyung J / Speziale, Giuseppe / Girardi, Leonard N / Taggart, David P / Anonymous4170945. ·From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York · Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom · Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.) · the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy · the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia · Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.) · and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.). ·N Engl J Med · Pubmed #29708851.

ABSTRACT: BACKGROUND: The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. METHODS: Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes. RESULTS: A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68). CONCLUSIONS: As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).

19 Article Significance of asymptomatic hyperuricemia in patients after coronary events. 2018

Tasić, Ivan / Kostić, Svetlana / Stojanović, Nikola M / Skakić, Vlado / Cvetković, Jovana / Djordjević, Aleksandar / Karadzić, Mirjana / Djordjević, Dragan / Andonov, Stanoje / Stoičkov, Viktor / Tasić, Dimitrije / Vanka, Meenakshi / Lović, Dragan. ·a Department of Internal Medicine, Faculty of Medicine , University of Niš , Niš , Serbia. · b Institute for Therapy and Rehabilitation 'Niška Banja' , Niška Banja , Serbia. · c Faculty of Medicine , University of Niš , Niš , Serbia. · d American University , Washington , DC , USA. · e Johns Hopkins University , Baltimore , MD , USA. · f Veterans Affairs Medical Center Washington USA , Washington , DC , USA. ·Scand J Clin Lab Invest · Pubmed #29703085.

ABSTRACT: The goal of the present study was to determine the prevalence of hyperuricemia in patients with coronary artery disease (CAD), within three months after coronary events. Also, we aimed to determine whether the presence of hyperuricemia holds correlation with severe CAD, overall heart functioning and risk factors for CAD. The study included 505 consecutive CAD patients, 385 males and 120 females, aged 60.9 ± 9.6 years, with a mean body mass index (BMI) 28.0 ± 3.7 kg/m

20 Article Novel Assessment Tool For Coronary Artery Disease Severity During Screening Mammography. 2018

Ružičić, Dušan / Dobrić, Milan / Vuković, Mira / Hrnčić, Dragan / Đorđević, Slavica / Ružičić, Milijana / Aleksandrić, Srđan / Đorđević-Dikić, Ana / Beleslin, Branko. ·a General Hospital Valjevo, Department of Cardiology and Invasive Cardiology. · b Cardiology Clinic , Clinical Center of Serbia, Faculty of Medicine, University of Belgrade. · d Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade. · c General Hospital Valjevo, Department of Radiology. ·Health Care Women Int · Pubmed #29648938.

ABSTRACT: Breast arterial calcifications (BACs) are common findings on mammography which are associated with an increased risk of the coronary artery disease (CAD). Our aim in the current study was to design measurement instruments of CAD prediction, with or without BACs, and its discriminatory validity in the diagnosis of CAD (expressed by Syntax score) in women. This was observational, prospective study in the women cohort which underwent mammography and angiography. In this study we have demonstrated that the total 'The Breast Arterial Calcification and Coronary Artery Disease Scale' (BACCADS) was good additional diagnostic tool for detection of patients with severe CAD.

21 Article Increased left ventricular mass index is present in patients with type 2 diabetes without ischemic heart disease. 2018

Seferovic, Jelena P / Tesic, Milorad / Seferovic, Petar M / Lalic, Katarina / Jotic, Aleksandra / Biering-Sørensen, Tor / Giga, Vojislav / Stankovic, Sanja / Milic, Natasa / Lukic, Ljiljana / Milicic, Tanja / Macesic, Marija / Gajovic, Jelena Stanarcic / Lalic, Nebojsa M. ·Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia. jpseferovic@gmail.com. · University of Belgrade, Faculty of Medicine, Belgrade, Serbia. jpseferovic@gmail.com. · Clinic of Cardiology, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia. · University of Belgrade, Faculty of Medicine, Belgrade, Serbia. · Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia. · Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Center for Medical Biochemistry, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. · Institute of Medical Statistics, Faculty of Medicine, Dr. Subotića 15, Belgrade, Serbia. ·Sci Rep · Pubmed #29343820.

ABSTRACT: Left ventricular mass index (LVMI) increase has been described in hypertension (HTN), but less is known about its association with type 2 diabetes (T2DM). As these conditions frequently co-exist, we investigated the association of T2DM, HTN and both with echocardiographic parameters, and hypothesized that patients with both had highest LVMI, followed by patients with only T2DM or HTN. Study population included 101 T2DM patients, 62 patients with HTN and no T2DM, and 76 patients with T2DM and HTN, excluded for ischemic heart disease. Demographic and clinical data, biochemical measurements, stress echocardiography, transthoracic 2D Doppler and tissue Doppler echocardiography were performed. Multivariable logistic regression was used to determine the independent association with T2DM. Linear regression models and Pearson's correlation were used to assess the correlations between LVMI and other parameters. Patients with only T2DM had significantly greater LVMI (84.9 ± 20.3 g/m

22 Article The HACD4 haplotype as a risk factor for atherosclerosis in males. 2018

Zivotić, Ivan / Djurić, Tamara / Stanković, Aleksandra / Ivančević, Ilija / Končar, Igor / Milasinovic, Dejan / Stankovic, Goran / Alavantić, Dragan / Zivković, Maja. ·Laboratory for Radiobiology and Molecular Genetics, VINCA Institute of Nuclear Sciences, University of Belgrade, 11000 Belgrade, Serbia. · School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; Clinic for the Vascular and Endovascular Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia. · Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia. · School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia. · Laboratory for Radiobiology and Molecular Genetics, VINCA Institute of Nuclear Sciences, University of Belgrade, 11000 Belgrade, Serbia. Electronic address: majaz@vinca.rs. ·Gene · Pubmed #29031776.

ABSTRACT: The 9p21.3 region is rich in regulatory elements and the variants in this region had been robustly associated with carotid plaque (CP) and coronary artery disease (CAD). Recently, the HACD4 was detected as one of the six 9p21.3 differentially expressed genes associated with accelerated atherosclerosis and greater mean lesion area in the Athsq1 congenic mice. We aimed to investigate association of two potentially regulatory HACD4 variants (rs36212560 I/D, rs2275888 T/C) and their haplotypes with CP occurrence and the level of HACD4 and FOCAD mRNA in human CP tissue. Association study was replicated in CAD patients who suffered the first myocardial infarction. Study included 477 CP patients, 303 healthy controls and replication sample of 224 CAD males from the population of Serbia. Genotypes were determined by polymerase chain reaction (PCR) and real-time PCR using TaqMan® technology. The gene expression was detected with TaqMan® technology. We have found significant and independent association of DT haplotype with CP presence in men (adjusted OR=1.64 CI=1.12-2.42, p=0.011). The result was replicated in CAD males (adjusted OR=1.84 CI=1.21-2.80, p=0.004). We have found significant effect of the HACD4 rs2275888 on FOCAD mRNA level in human CP tissue. Correction for multiple testing was performed. Independent association of HACD4 haplotypes with atherosclerotic phenotypes connotes a further validation and replication in larger cohorts as well as functional studies to enlighten the potential mechanism of its action in pathophysiology of atherosclerosis.

23 Article Ischaemic heart disease mortality in Serbia, 1991-2013; a joinpoint analysis. 2017

Ilic, Milena / Ilic, Irena. ·Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia. · Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia. ·Indian J Med Res · Pubmed #29664033.

ABSTRACT: Background & objectives: Ischaemic heart disease (IHD) has been one of the leading causes of mortality in the world. In many European countries the mortality rates due to IHD have been rising rapidly. This study was aimed to assess the IHD mortality trend in Serbia. Methods: A population-based cross-sectional study analyzing IHD mortality in Serbia in the period 1991-2013 was carried out based on official data. The age-standardized rates (ASRs, per 100,000) were calculated using the direct method, according to the European standard population. Joinpoint analysis was used to estimate the average annual percentage change (AAPC) with the corresponding 95 per cent confidence interval (CI). Results: More than 253,000 people (143,420 men and 110,276 women) died due to IHD in Serbia during the observed period, and most of them (over 160,000 people) were patients with myocardial infarction (MI). Average annual ASR for IHD was 113.6/100,000. There was no overall significant trend for mortality due to IHD (AAPC=+0.1%, 95% CI -0.8-1.0), but there was one joinpoint: the trend significantly increased by +2.3 per cent per year from 1991 to 2006 and then significantly decreased by -6.4 per cent from 2006 to onwards. Significantly decreased mortality trends for MI in both genders were observed: according to the comparability test, mortality trends in men and women were parallel (final selected model failed to reject parallelism, P=0.0567). Interpretation & conclusions: No significant trend for mortality due to IHD was observed in Serbia during the study period. The substantial decline of mortality from IHD seen in most developed countries during the past decades was not observed in Serbia. Further efforts are required to reduce mortality from IHD in Serbian population.

24 Article Comparison of Risk 'Scores' Performances for Combined Aortic Valve Replacement and Coronary Artery Bypass Surgery. 2017

Nezic, Dusko. ·Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia. Electronic address: nezic@eunet.rs. ·Heart Lung Circ · Pubmed #28985795.

ABSTRACT: -- No abstract --

25 Article Stress hormones at rest and following exercise testing predict coronary artery disease severity and outcome. 2017

Popovic, Dejana / Damjanovic, Svetozar / Djordjevic, Tea / Martic, Dejana / Ignjatovic, Svetlana / Milinkovic, Neda / Banovic, Marko / Lasica, Ratko / Petrovic, Milan / Guazzi, Marco / Arena, Ross. ·a Division of Cardiology , University of Belgrade , Belgrade , Serbia. · b Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia. · c Division of Endocrinology , University of Belgrade , Belgrade , Serbia. · d Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology , I.R.C.C.S, Policlinico San Donato University Hospital , Milan , Italy. · e Department of Physical Therapy, College of Applied Health Sciences , University of Illinois Chicago , Chicago , IL , USA. ·Stress · Pubmed #28845719.

ABSTRACT: OBJECTIVES: Despite considerable knowledge regarding the importance of stress in coronary artery disease (CAD) pathogenesis, its underestimation persists in routine clinical practice, in part attributable to lack of a standardized, objective assessment. The current study examined the ability of stress hormones to predict CAD severity and prognosis at basal conditions as well as during and following an exertional stimulus. MATERIALS AND METHODS: Forty Caucasian subjects with significant coronary artery lesions (≥50%) were included. Within 2 months of coronary angiography, cardiopulmonary exercise testing (CPET) on a recumbent ergometer was performed in conjunction with stress echocardiography (SE). At rest, peak and after 3 min of recovery following CPET, plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and NT-pro-brain natriuretic peptide (NT-pro-BNP) were measured by immunoassay sandwich technique, radioimmunoassay, and radioimmunometric technique, respectively. Subjects were subsequently followed a mean of 32 ± 10 months. RESULTS AND DISCUSSION: Mean ejection fraction was 56.7 ± 9.6%. Subjects with 1-2 stenotic coronary arteries (SCA) demonstrated a significantly lower plasma cortisol levels during CPET compared to those with 3-SCA (p < .05), whereas ACTH and NT-pro-BNP were not significantly different (p > .05). Among CPET, SE, and hormonal parameters, cortisol at rest and during CPET recovery demonstrated the best predictive value in distinguishing between 1-, 2-, and 3-SCA [area under ROC curve 0.75 and 0.77 (SE = 0.11, 0.10; p = .043, .04) for rest and recovery, respectively]. ΔCortisol peak/rest predicted cumulative cardiac events (area under ROC curve 0.75, SE = 0.10, p = .049). CONCLUSIONS: Cortisol at rest and following an exercise test holds predictive value for CAD severity and prognosis, further demonstrating a link between stress and unwanted cardiac events.

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