Zorica Savovic, Violeta Iric-Cupic and Goran Davidovic
Given Taking that the TIMI score is a major predictor of MACE, this study aimed to determine the value of the TIMI risk score in predicting poor outcomes (death, myocardial infarction, recurrent pain) in patients presenting with unstable angina pectoris in short-term observation. A total of 107 patients with APns were examined at the Clinical Centre Kragujevac and were included in the investigation. The TIMI score was determined on the first day of hospitalization. During hospitalization, the following factors were also observed: troponin, ECG evolution, further therapy (pharmacologic therapy and/or emergency PCI or CABG), age, hypertension and hyperlipidaemia. The low-risk group (TIMI 0 - 2) included 30.8% of patients, whereas 47.6% of patients were in the intermediate-risk group (TIMI 3 - 4), and 21.5% of patients were in the high-risk group (TIMI 5 - 7). Good outcomes (without adverse event) and poor outcomes (death, myocardial infarction, and recurring chest pain) were dependent on the TIMI risk score. The increase in TIMI risk score per one unit increased the risk of a poor outcome by 54%. Troponin and TIMI risk score were positively correlated. Our results suggest that the TIMI risk score may be a reliable predictor of a poor outcome (MACE) during the short-term observation of patients with APns. Moreover, patients identified as high-risk benefit from early invasive PCI, enoxaparin and Gp IIb/IIIa inhibitors. Th us, routine use of the TIMI risk score at admission may reduce the number of patients not recognized as high-risk.
Dragan Panic, Andreja Todorovic, Milica Stanojevic and Violeta Iric Cupic
Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropneumonia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered.
Ivan Simic, Vladimir Zdravkovic, Rada Vucic, Violeta Iric-Cupic, Goran Davidovic, Vladimir Ignjatovic and Dragic Bankovic
Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities.
Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions.
Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization.
Results: Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005).
Conclusion: Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI.
Violeta Iric-Cupic, Srdjan Milanov, Goran Davidovic, Vladimir Zdravkovic, Jelena Vuckovic-Filipovic, Rada Vucic and Ivan Simic
Background: Ischemic heart disease (IHD) is a most common manifestation of generalised atherosclerosis. Hyperlipidemia is one of the most significant risk factors causing atherosclerosis. Becouse of this, statin therapy is the (guideline) in therapy of hyperlipoproteinemia.
Aim: The aim of this study was to show the hypolipemic effect of statins.
Material and Methods: The research included 74 patients with hyperlipoproteinemia type II and III, with (59 patients) or without (15) coronary disease diagnosis. All patients have been treated with statins. In all patients, we analizing statins hypolipemic effects, and the research was carried out: before therapy, after 2 and 6 weeks, 3 months, and than every 3 months during 2 years of treatment.
Results: Target value of lipoprotein profile parameter is achieved after 3-6 months of statin treatment. According to the results HDL-cholesterol was changed with the statins for 12.5% average; the highest average value change of 27.5% was recorded at the end of follow-up, and the minimal mean change, observed 2 weeks after therapy initiation was 4.59%.
Conclusion: The statin therapy has significant effect on lipoprotein profile and atherogenic index. That effect is the most intensive after 3 month therapy, and target level of lipoprotein parameter are achieved after 3-6 months of statin treatment.
Goran Davidovic, Violeta Iric-Cupic, Srdjan Milanov, Ivan Simic, Ziva Zivic and Mirjana Janicijevic-Petrovic
Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“.
Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“.
Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations.
Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese.
Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.