The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy
Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by an...
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| Format: | Article |
| Language: | English |
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2022-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502000090K.pdf |
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| author | Krljanac Gordana Ašanin Milika Mickovski-Katalina Nataša Milanović Slađan D. Bjekić Jovana Savić Lidija Mitrović Predrag Đurović Marina Vasiljević Zorana |
| author_facet | Krljanac Gordana Ašanin Milika Mickovski-Katalina Nataša Milanović Slađan D. Bjekić Jovana Savić Lidija Mitrović Predrag Đurović Marina Vasiljević Zorana |
| author_sort | Krljanac Gordana |
| collection | DOAJ |
| description | Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748–0.761)] were a ge ( ≥ 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus. |
| format | Article |
| id | doaj-art-f7afebcfe11c45708d0a0c441ae57e06 |
| institution | DOAJ |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-f7afebcfe11c45708d0a0c441ae57e062025-08-20T03:06:16ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202022-01-0179322122910.2298/VSP190118090K0042-84502000090KThe use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategyKrljanac Gordana0https://orcid.org/0000-0002-4849-7031Ašanin Milika1https://orcid.org/0000-0001-8493-0499Mickovski-Katalina Nataša2Milanović Slađan D.3Bjekić Jovana4https://orcid.org/0000-0001-7413-0324Savić Lidija5Mitrović Predrag6https://orcid.org/0000-0002-1350-668XĐurović Marina7Vasiljević Zorana8University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, SerbiaUniversity Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, SerbiaInstitute of Public Health of Serbia “Dr. Milan Jovanović Batut”, Center for Prevention and Control of Diseases, Department for Prevention and Control of Noncommunicable Diseases, Belgrade, SerbiaUniversity of Belgrade, Institute for Medical Research, Belgrade, SerbiaUniversity of Belgrade, Institute for Medical Research, Belgrade, SerbiaUniversity Clinical Center of Serbia, Clinic of Cardiology, Belgrade, SerbiaUniversity Clinical Center of Serbia, Clinic of Cardiology, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Clinical Center of Serbia, Clinic of Endocrinology, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Belgrade, SerbiaBackground/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748–0.761)] were a ge ( ≥ 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus.http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502000090K.pdfdrug therapyst elevation myocardial infarctionmyocardial reperfusionrisk factorsserbiatreatment outcome |
| spellingShingle | Krljanac Gordana Ašanin Milika Mickovski-Katalina Nataša Milanović Slađan D. Bjekić Jovana Savić Lidija Mitrović Predrag Đurović Marina Vasiljević Zorana The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy Vojnosanitetski Pregled drug therapy st elevation myocardial infarction myocardial reperfusion risk factors serbia treatment outcome |
| title | The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| title_full | The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| title_fullStr | The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| title_full_unstemmed | The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| title_short | The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| title_sort | use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy |
| topic | drug therapy st elevation myocardial infarction myocardial reperfusion risk factors serbia treatment outcome |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502000090K.pdf |
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