Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e100666
G. Slavchev, N. Mileva, A. Dacheva, E. Mekov, S. Dzhambazov, D. Vassilev
Introduction: Fractional fl ow reserve (FFR) implies the ratio of the maximal hyperemic myocardial blood fl ow in the case of a pathologically changed coronary artery to the maximal hyperemic myocardial blood fl ow in the case of a healthy coronary artery. Aims: The aim of the current study is to perform an economic evaluation and budget impact analysis of measuring FFR as a medical activity in Bulgaria. Material and Methods: For the purpose of the current analysis, two models using Microsoft Excel and TreeAge Pro were developed to evaluate the cost-effectiveness of the FFR-guided percutaneous coronary intervention (PCI) compared to the classic angiography-guided PCI in patients with ischemic heart disease (IHD) with one-vessel coronary artery disease (CAD) or multivessel CAD. The analysis will focus on the health perspective and the payer perspective - National Health Insurance Fund (NHIF). Results: The medico-diagnostic activity related to measuring FFR in patients with multi-vessel coronary artery disease is shown to be a cost-effective therapeutic approach in Bulgaria compared to the angiography-guided PCI (ICER = 50 456 BGN/QALY) with a cost-effectiveness threshold of 51 510 BGN/QALY. FFR- guided PCI strategy in one-vessel coronary artery disease patients is a cost-saving approach (-853 BGN) when compared to the angiography-guided PCI (4 150 BGN). Conclusion: Budget impact analysis revealed that the FFR-guided PCI strategy is a cost-saving alternative approach to the angiographyguided PCI. The savings of the NHIF during the fi rst year of reimbursement of FFR would be -1,1 million BGN and could reach -1,6 million BGN in the third year.
{"title":"Economic evaluation and analysis of the budget effect of the measuring of fractional flow reserve in Bulgaria","authors":"G. Slavchev, N. Mileva, A. Dacheva, E. Mekov, S. Dzhambazov, D. Vassilev","doi":"10.3897/bgcardio.29.e100666","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e100666","url":null,"abstract":"Introduction: Fractional fl ow reserve (FFR) implies the ratio of the maximal hyperemic myocardial blood fl ow in the case of a pathologically changed coronary artery to the maximal hyperemic myocardial blood fl ow in the case of a healthy coronary artery. Aims: The aim of the current study is to perform an economic evaluation and budget impact analysis of measuring FFR as a medical activity in Bulgaria. Material and Methods: For the purpose of the current analysis, two models using Microsoft Excel and TreeAge Pro were developed to evaluate the cost-effectiveness of the FFR-guided percutaneous coronary intervention (PCI) compared to the classic angiography-guided PCI in patients with ischemic heart disease (IHD) with one-vessel coronary artery disease (CAD) or multivessel CAD. The analysis will focus on the health perspective and the payer perspective - National Health Insurance Fund (NHIF). Results: The medico-diagnostic activity related to measuring FFR in patients with multi-vessel coronary artery disease is shown to be a cost-effective therapeutic approach in Bulgaria compared to the angiography-guided PCI (ICER = 50 456 BGN/QALY) with a cost-effectiveness threshold of 51 510 BGN/QALY. FFR- guided PCI strategy in one-vessel coronary artery disease patients is a cost-saving approach (-853 BGN) when compared to the angiography-guided PCI (4 150 BGN). Conclusion: Budget impact analysis revealed that the FFR-guided PCI strategy is a cost-saving alternative approach to the angiographyguided PCI. The savings of the NHIF during the fi rst year of reimbursement of FFR would be -1,1 million BGN and could reach -1,6 million BGN in the third year.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46638081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e105978
B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, K. Stanev, N. Ivanova, P. Nikolov, M. Tokmakova
Infective endocarditis (IE) marks an increasing morbidity and unchanged mortality despite advances in its diagnosis and treatment. In about 20% of IE cases are acute, with signs of sepsis and septic shock. Septic shock dramatically worsens prognosis and is an independent predictor of in – hospital death. Timely diagnosis and urgent surgical intervention can improve survival in these patients. We present a case of a 47-year-old man, with no history of past or concomitant diseases, who was admitted as an emergency to the Cardiology Intensive Care Unit, during the Covid-19 pandemic, with pronounced febrile-intoxication syndrome, shortness of breath, precordial discomfort and pain, cough, haemoptysis. From laboratory studies with a pronounced infl ammatory constellation, troponin I and D-dimers are also increased. This case shows the diffi culties in the diagnosis of acute IE, the specifi cs in the clinical course of the disease, as well as the importance of urgent surgical intervention to improve survival.
{"title":"A case of acute infective endocarditis and septic shock","authors":"B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, K. Stanev, N. Ivanova, P. Nikolov, M. Tokmakova","doi":"10.3897/bgcardio.29.e105978","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e105978","url":null,"abstract":"Infective endocarditis (IE) marks an increasing morbidity and unchanged mortality despite advances in its diagnosis and treatment. In about 20% of IE cases are acute, with signs of sepsis and septic shock. Septic shock dramatically worsens prognosis and is an independent predictor of in – hospital death. Timely diagnosis and urgent surgical intervention can improve survival in these patients. We present a case of a 47-year-old man, with no history of past or concomitant diseases, who was admitted as an emergency to the Cardiology Intensive Care Unit, during the Covid-19 pandemic, with pronounced febrile-intoxication syndrome, shortness of breath, precordial discomfort and pain, cough, haemoptysis. From laboratory studies with a pronounced infl ammatory constellation, troponin I and D-dimers are also increased. This case shows the diffi culties in the diagnosis of acute IE, the specifi cs in the clinical course of the disease, as well as the importance of urgent surgical intervention to improve survival.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43720700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e108621
B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, I. Manolov, P. Nikolov, N. Ivanova, D. Iovanovska, I. Kuchmov, M. Tokmakova
According to the mode of acquisition, infective endocarditis (IE) is classifi ed as community-acquired (CAIE), healthcareassociated (HAIE), and injection drug use–related IE (IDUIE). At this stage, there are no data for Bulgaria for these three groups of patients. Objective: We set ourselves the goal of investigating IE according to the mode of acquisition and to make a clinical-instrumental characterization of the groups. Material and methods: The study is single-center, retrospective and includes 270 patients treated at the UMHAT “Sveti Georgi” – Plovdiv for the period 01.2005-12. 2021. Results: Patients with CAIE were 64.8% (175), with HAIE 26.7% (72) and with IDUIE 8.5% (23). Patients with IDUIE are younger compared to the other two groups (33; 8 years) (p = 0.000), with low comorbidity (CCI – 1, IQR – 1; p = 0.000), with most frequent right-sided involvement (p < 0.001) and with the most common causative agent being Staphylococcus aureus (p < 0.01). Patients with HAIE were the oldest (69; 18 years;), with the most comorbidity (CCI – 4; IQR – 3), with no signifi cant difference with CAIE (66; 20 years; and CCI – 3; IQR – 3). The large proportion of portal of entry for them were manipulations/ procedures (62.5%) and hemodialysis (18.1%), with Enterococci being the most common causative agent (19.5%, p = 0.001). In-hospital mortality and early surgical intervention were without signifi cant difference in the three groups. Conclusion: Knowledge of the three groups of IE according to the mode of acquisition – CAIE, HAIE and IDUIE and their characteristics is important for the choice of initial empiric antibiotic treatment and for improvement of prevention.
{"title":"Characteristics of infective endocarditis according to the mode of acquisition – a single-center, retrospective analysis","authors":"B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, I. Manolov, P. Nikolov, N. Ivanova, D. Iovanovska, I. Kuchmov, M. Tokmakova","doi":"10.3897/bgcardio.29.e108621","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e108621","url":null,"abstract":"According to the mode of acquisition, infective endocarditis (IE) is classifi ed as community-acquired (CAIE), healthcareassociated (HAIE), and injection drug use–related IE (IDUIE). At this stage, there are no data for Bulgaria for these three groups of patients. Objective: We set ourselves the goal of investigating IE according to the mode of acquisition and to make a clinical-instrumental characterization of the groups. Material and methods: The study is single-center, retrospective and includes 270 patients treated at the UMHAT “Sveti Georgi” – Plovdiv for the period 01.2005-12. 2021. Results: Patients with CAIE were 64.8% (175), with HAIE 26.7% (72) and with IDUIE 8.5% (23). Patients with IDUIE are younger compared to the other two groups (33; 8 years) (p = 0.000), with low comorbidity (CCI – 1, IQR – 1; p = 0.000), with most frequent right-sided involvement (p < 0.001) and with the most common causative agent being Staphylococcus aureus (p < 0.01). Patients with HAIE were the oldest (69; 18 years;), with the most comorbidity (CCI – 4; IQR – 3), with no signifi cant difference with CAIE (66; 20 years; and CCI – 3; IQR – 3). The large proportion of portal of entry for them were manipulations/ procedures (62.5%) and hemodialysis (18.1%), with Enterococci being the most common causative agent (19.5%, p = 0.001). In-hospital mortality and early surgical intervention were without signifi cant difference in the three groups. Conclusion: Knowledge of the three groups of IE according to the mode of acquisition – CAIE, HAIE and IDUIE and their characteristics is important for the choice of initial empiric antibiotic treatment and for improvement of prevention.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41963930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e106477
S. Nikolaeva, A. Angelov
Chronic obstructive pulmonary disease is a cause of morbidity and mortality worldwide. The presence of infl ammatory markers in circulation, sputum, and broncho-alveolar fl uid suggest systemic infl ammation is one of the potential mechanisms responsible for both chronic obstructive pulmonary disease and metabolic syndrome. Circulating markers of infl ammation, on the other hand, are those that have been found to predict future cardiovascular events as well. One of the main causes of increased cardiovascular risk in patients with chronic obstructive pulmonary disease and metabolic syndrome is hyperglycemia. It induces oxidative stress and subsequently micro- and macrovascular complications. This review describes in details the various components of metabolic syndrome and its impact on long outcomes in chronic obstructive pulmonary disease and cardiovascular pathology.
{"title":"Cardiovascular risk in patients with chronic obstructive pulmonary disease and metabolic syndrome","authors":"S. Nikolaeva, A. Angelov","doi":"10.3897/bgcardio.29.e106477","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e106477","url":null,"abstract":"Chronic obstructive pulmonary disease is a cause of morbidity and mortality worldwide. The presence of infl ammatory markers in circulation, sputum, and broncho-alveolar fl uid suggest systemic infl ammation is one of the potential mechanisms responsible for both chronic obstructive pulmonary disease and metabolic syndrome. Circulating markers of infl ammation, on the other hand, are those that have been found to predict future cardiovascular events as well. One of the main causes of increased cardiovascular risk in patients with chronic obstructive pulmonary disease and metabolic syndrome is hyperglycemia. It induces oxidative stress and subsequently micro- and macrovascular complications. This review describes in details the various components of metabolic syndrome and its impact on long outcomes in chronic obstructive pulmonary disease and cardiovascular pathology.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48148693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e106652
M. Rushid, Y. Yotov, A. Kisheva
Since 2019, humanity has been relentlessly fi ghting the pandemic caused by the SARS-CoV-2 virus. Respiratory distress syndrome is the main clinical manifestation of COVID-19, which often results in full recovery but can also end fatally. Of interest to modern medicine is a small group of patients in whom the disease persists for months, known as “Long COVID.” This condition predisposes to the development of a rare but life-threatening syndrome, manifested and defi ned as one of the most serious complications of SARS-CoV-2 infection – multisystem Infl ammatory Syndrome in Adults (MIS-A). This syndrome was fi rst described in children and called MIS-C (Multisystem Infl ammatory Syndrome in Children). The affected population consists of patients ≥ 21 years old, regardless of gender. Despite numerous studies, clinical-laboratory and demographic analyses, there are still disagreements regarding the frequency of occurrence, pathogenesis, and diagnostic-therapeutic algorithm for these patients. The purpose of this article is to systematize the congested experience and knowledge, as well as to demonstrate their application in clinical practice.
{"title":"Multisystem inflammatory syndrome in adults: new insights into a rare but serious complication of COVID-19","authors":"M. Rushid, Y. Yotov, A. Kisheva","doi":"10.3897/bgcardio.29.e106652","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e106652","url":null,"abstract":"Since 2019, humanity has been relentlessly fi ghting the pandemic caused by the SARS-CoV-2 virus. Respiratory distress syndrome is the main clinical manifestation of COVID-19, which often results in full recovery but can also end fatally. Of interest to modern medicine is a small group of patients in whom the disease persists for months, known as “Long COVID.” This condition predisposes to the development of a rare but life-threatening syndrome, manifested and defi ned as one of the most serious complications of SARS-CoV-2 infection – multisystem Infl ammatory Syndrome in Adults (MIS-A). This syndrome was fi rst described in children and called MIS-C (Multisystem Infl ammatory Syndrome in Children). The affected population consists of patients ≥ 21 years old, regardless of gender. Despite numerous studies, clinical-laboratory and demographic analyses, there are still disagreements regarding the frequency of occurrence, pathogenesis, and diagnostic-therapeutic algorithm for these patients. The purpose of this article is to systematize the congested experience and knowledge, as well as to demonstrate their application in clinical practice.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43902052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e105505
B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, I. Manolov, K. Stanev, N. Ivanova, M. Tokmakova
Infective endocarditis (IE) is an infl ammatory disease of the endocardium of the heart affecting heart valves (native or prosthetic) and, in the last few decades, also available intracardiac permanent devices or catheters. Despite technological progress and accumulated experience, this disease continues to be a huge challenge for doctors in terms of diagnosis, treatment and improvement of survival. The clinical picture is atypical and heterogeneous, with different clinical "masks" of other diseases – infectious, oncological, hematological, rheumatological, neurological, etc. Embolic complications are often the fi rst manifestation of the disease and are most often cerebral. We present a clinical case of a 29-year-old woman with acute neurological symptoms as a fi rst manifestation of IE. This case refl ects the atypical clinical presentation of the disease, the importance of new imaging modalities for the precise diagnosis of neurological complications, and the decision on the timing of operative intervention when indicated. The question of IE prophylaxis in moderate-risk patients, such as those with mitral valve prolapse and bicuspid aortic valve, remains open.
{"title":"Acute neurological symptoms as a debut of infective endocarditis","authors":"B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, I. Manolov, K. Stanev, N. Ivanova, M. Tokmakova","doi":"10.3897/bgcardio.29.e105505","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e105505","url":null,"abstract":"Infective endocarditis (IE) is an infl ammatory disease of the endocardium of the heart affecting heart valves (native or prosthetic) and, in the last few decades, also available intracardiac permanent devices or catheters. Despite technological progress and accumulated experience, this disease continues to be a huge challenge for doctors in terms of diagnosis, treatment and improvement of survival. The clinical picture is atypical and heterogeneous, with different clinical \"masks\" of other diseases – infectious, oncological, hematological, rheumatological, neurological, etc. Embolic complications are often the fi rst manifestation of the disease and are most often cerebral. We present a clinical case of a 29-year-old woman with acute neurological symptoms as a fi rst manifestation of IE. This case refl ects the atypical clinical presentation of the disease, the importance of new imaging modalities for the precise diagnosis of neurological complications, and the decision on the timing of operative intervention when indicated. The question of IE prophylaxis in moderate-risk patients, such as those with mitral valve prolapse and bicuspid aortic valve, remains open.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41409468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.3897/bgcardio.29.e100555
I. Zheleva-Kyuchukova, V. Gelev
Background: Acute coronary syndrome with ST elevation (STEMI) with a lesion in the left main coronary artery (LMCA) occurs infrequently; moreover, patients are at very high risk for mortality. However, limited data are available regarding the prevalence, clinical characteristics, and outcomes of patients presenting with LM-STEMI treated with percutaneous coronary intervention (LM-PCI STEMI). Therefore, we aimed to evaluate patient clinical and procedure factors associated with in-hospital outcomes in LM-STEMI patients undergoing PPCI in a real-life registry. Material and methods: From 439 consecutive patients with LM disease treated with PCI in the prospective single-center Acibadem City Clinic UMHAT Tokuda registry enrolled between March 2013 and October 2022, we identifi ed 35 LM-PCI STEMI patients (8%). We analyzed baseline demographic, coronary lesion characteristics, procedural details and success, and in-hospital mortality. Results: Among 35 LM-STEMI patients, the mean age was 66.0 ± 16 years, and 69% were male – forty percent presented with cardiogenic shock (CS). The risk profi le of the overall study population was relatively high (mean Euro Score (ES) was 19.1 ± 22, while 54.3% were high risk with ES > 6). Radial access had a remarkably high proportion (68.6%), regardlessof coronary anatomic complexity being intermediate to high (mean Syntax Score (SS) was 29.5 ± 8,15, 42,9% had SS ≥ 32). The distal LM bifurcation was most commonly involved (82.9%), yet the provisional strategy (85.7%) was most often employed during emergent PCI. The observed overall in-hospital mortality rate was 25.7% (64.3% in pts presenting with CS vs. 23.5% without CS, p = 0.0166). Conclusion: STEMI from culprit LMCA lesion is associated with signifi cant mortality. Emergent LM PCI in unselected patients, including cardiogenic shock, is an appropriate and feasible treatment option for this high-risk group, with acceptable mortality and in-hospital survival rates.
背景：急性冠状动脉综合征伴ST段抬高（STEMI）伴左冠状动脉主干（LMCA）病变的发生率较低；此外，患者的死亡率非常高。然而，关于经皮冠状动脉介入治疗的LM-STEMI患者的患病率、临床特征和结果的可用数据有限。因此，我们的目的是在现实生活中评估与接受PPCI的LM-STEMI患者住院结果相关的患者临床和手术因素。材料和方法：从2013年3月至2022年10月在UMHAT Tokuda Acibadem City Clinic前瞻性单中心注册中心接受PCI治疗的439名LM疾病患者中，我们确定了35名LM-PCI STEMI患者（8%）。我们分析了基线人口统计学、冠状动脉病变特征、手术细节和成功率以及住院死亡率。结果：在35名LM-STEMI患者中，平均年龄为66.0±16岁，69%为男性，40%为心源性休克（CS）。总体研究人群的风险收益相对较高（平均欧洲评分（ES）为19.1±22，而ES>6的高风险人群占54.3%）。桡动脉入路的比例非常高（68.6%），尽管冠状动脉解剖复杂性为中高（平均语法得分（SS）为29.5±8.15，42.9%的患者SS≥32）。远端LM分叉最常见（82.9%），但在急诊PCI期间最常采用临时策略（85.7%）。观察到的总住院死亡率为25.7%（CS患者为64.3%，非CS患者为23.5%，p=0.0166）。结论：罪犯LMCA病变引起的STEMI与显著的死亡率相关。对未经选择的患者（包括心源性休克）进行紧急LM PCI是这一高危人群的一种适当可行的治疗选择，具有可接受的死亡率和住院生存率。
{"title":"Immediate outcome after percutaneous coronary revascularization in STEMI for left main coronary artery lesions","authors":"I. Zheleva-Kyuchukova, V. Gelev","doi":"10.3897/bgcardio.29.e100555","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e100555","url":null,"abstract":"Background: Acute coronary syndrome with ST elevation (STEMI) with a lesion in the left main coronary artery (LMCA) occurs infrequently; moreover, patients are at very high risk for mortality. However, limited data are available regarding the prevalence, clinical characteristics, and outcomes of patients presenting with LM-STEMI treated with percutaneous coronary intervention (LM-PCI STEMI). Therefore, we aimed to evaluate patient clinical and procedure factors associated with in-hospital outcomes in LM-STEMI patients undergoing PPCI in a real-life registry. Material and methods: From 439 consecutive patients with LM disease treated with PCI in the prospective single-center Acibadem City Clinic UMHAT Tokuda registry enrolled between March 2013 and October 2022, we identifi ed 35 LM-PCI STEMI patients (8%). We analyzed baseline demographic, coronary lesion characteristics, procedural details and success, and in-hospital mortality. Results: Among 35 LM-STEMI patients, the mean age was 66.0 ± 16 years, and 69% were male – forty percent presented with cardiogenic shock (CS). The risk profi le of the overall study population was relatively high (mean Euro Score (ES) was 19.1 ± 22, while 54.3% were high risk with ES > 6). Radial access had a remarkably high proportion (68.6%), regardlessof coronary anatomic complexity being intermediate to high (mean Syntax Score (SS) was 29.5 ± 8,15, 42,9% had SS ≥ 32). The distal LM bifurcation was most commonly involved (82.9%), yet the provisional strategy (85.7%) was most often employed during emergent PCI. The observed overall in-hospital mortality rate was 25.7% (64.3% in pts presenting with CS vs. 23.5% without CS, p = 0.0166). Conclusion: STEMI from culprit LMCA lesion is associated with signifi cant mortality. Emergent LM PCI in unselected patients, including cardiogenic shock, is an appropriate and feasible treatment option for this high-risk group, with acceptable mortality and in-hospital survival rates.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45602705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.3897/bgcardio.29.e101578
M. Stoyanov, T. Shalganov
Ventricular arrhythmias are among the most serious complications of myocardial infarction that defi ne not only increased morbidity and mortality, but also signifi cantly impaired quality of life. The pathogenesis of ventricular arrhythmias that arise during and after myocardial infarction is a combination of various triggering and modulating factors. We present a summary of the main structural and functional changes that occur with myocardial ischemia and create substrate for ventricular arrhythmias. The electrophysiological mechanisms underlying infarction-related ventricular arrhythmias are reviewed, as well as the most common pharmacological and non-pharmacological treatment’s strategies.
{"title":"Myocardial infarction-related ventricular arrhythmias","authors":"M. Stoyanov, T. Shalganov","doi":"10.3897/bgcardio.29.e101578","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e101578","url":null,"abstract":"Ventricular arrhythmias are among the most serious complications of myocardial infarction that defi ne not only increased morbidity and mortality, but also signifi cantly impaired quality of life. The pathogenesis of ventricular arrhythmias that arise during and after myocardial infarction is a combination of various triggering and modulating factors. We present a summary of the main structural and functional changes that occur with myocardial ischemia and create substrate for ventricular arrhythmias. The electrophysiological mechanisms underlying infarction-related ventricular arrhythmias are reviewed, as well as the most common pharmacological and non-pharmacological treatment’s strategies.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46068455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.3897/bgcardio.29.e102027
A. Alexandrov, H. Mateev, G. Vladimirov, I. Bayraktarova, I. Petrova, E. Kostova-Dimitrova
Age is an important non-modifi able risk factor for cardiovascular disease. Both European and American guidelines recommend offering an invasive reperfusion strategy in elderly patients with ACS, taking into account the patients‘ comorbidities and baseline level of functioning. Materials and methods: All patients over 80 years of age with acute coronary syndrome, treated in the Department of Invasive Cardiology of the National Heart Hospital for the period between January 1, 2016. and December 31, 2018, are retrospectively analyzed. The primary endpoint was defi ned as all-cause mortality during the hospital stay and at follow-up. Predictors of mortality were assessed and independent predictors were identifi ed. Results: During the study period, 179 patients aged 80 years or older were identifi ed as being treated for ACS with PCI. In the study population, in hospital mortality for the index event was 11.8%. At a mean follow-up time of 20.19 ± 11.9 months, mortality rose signifi cantly to 64.6%. When evaluating in-hospital mortality on multivariate analysis, the two independent predictors were Cardiogenic shock (HR 0.005, 95% CI 0.01–0.44; p < 0.001) and acute/exacerbated renal failure (0.986 95% CI 0.984-0.997; p = 0.015). Conclusion: The present study provides important information regarding characteristics and outcomes in very elderly patients undergoing PCI for ACS. In the future, this subset of patients is predicted to grow, meaning that their approach must be evidence-based to ensure safe and effective treatment options.
{"title":"Percutaneous coronary interventions in patients over 80 years old age with acute coronary syndrome","authors":"A. Alexandrov, H. Mateev, G. Vladimirov, I. Bayraktarova, I. Petrova, E. Kostova-Dimitrova","doi":"10.3897/bgcardio.29.e102027","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e102027","url":null,"abstract":"Age is an important non-modifi able risk factor for cardiovascular disease. Both European and American guidelines recommend offering an invasive reperfusion strategy in elderly patients with ACS, taking into account the patients‘ comorbidities and baseline level of functioning. Materials and methods: All patients over 80 years of age with acute coronary syndrome, treated in the Department of Invasive Cardiology of the National Heart Hospital for the period between January 1, 2016. and December 31, 2018, are retrospectively analyzed. The primary endpoint was defi ned as all-cause mortality during the hospital stay and at follow-up. Predictors of mortality were assessed and independent predictors were identifi ed. Results: During the study period, 179 patients aged 80 years or older were identifi ed as being treated for ACS with PCI. In the study population, in hospital mortality for the index event was 11.8%. At a mean follow-up time of 20.19 ± 11.9 months, mortality rose signifi cantly to 64.6%. When evaluating in-hospital mortality on multivariate analysis, the two independent predictors were Cardiogenic shock (HR 0.005, 95% CI 0.01–0.44; p < 0.001) and acute/exacerbated renal failure (0.986 95% CI 0.984-0.997; p = 0.015). Conclusion: The present study provides important information regarding characteristics and outcomes in very elderly patients undergoing PCI for ACS. In the future, this subset of patients is predicted to grow, meaning that their approach must be evidence-based to ensure safe and effective treatment options.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42699847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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